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Biomedical subjects

K Dracup

Publications and source records attributed to K Dracup.

157 records · Page 9Linked to original sources
PubMedDate not supplied

Quality of life in patients with advanced heart failure.

Although evaluation of the treatment of congestive heart failure is usually based on objective clinical outcomes, patient self-assessment is increasingly recognized as an important component of evaluation. A study was designed to measure the quality of life of 134 patients with symptoms of advanced heart failure who were being evaluated for possible heart transplantation. The patients' quality of life was assessed using a mix of subjective and objective measures, including functional status, physical symptoms, emotional state, and psychosocial adaptation. There was no significant relationship between patients' cardiac ejection fraction and any quality-of-life measures; however, the results of a 6-minute walking test, New York Heart Association classification, and self-reported functional status were all significantly correlated with psychosocial adjustment. Self-reported functional status, depression, and hostility accounted for 43% of the variance in total psychosocial adjustment to illness. These findings support the inclusion of quality of life as an outcome measure in any evaluation of treatment efficacy and suggest that interventions to improve the quality of life of patients with advanced heart failure need to be targeted at reducing depression and hostility and increasing daily activity levels.

Activities of Daily Living↗
PubMedDate not supplied

Comparing methods of cardiopulmonary resuscitation instruction on learning and retention.

This article describes a study of two methods of teaching CPR where immediate and long-term retention of CPR skills and knowledge were compared. Forty-nine subjects were randomly assigned to either a control group (didactic instruction) or an experimental group (modular instruction). Knowledge retention was evaluated by means of a written examination. Skills retention was evaluated by the Mandel observation instrument. The knowledge and skills performance of both groups, immediately following the class and at 3 months follow up, were not significantly different. Based on these results, modular instruction appears to be an effective alternative to the conventional time-consuming and expensive method commonly used for CPR instruction.

Adult↗
PubMedDate not supplied

Patient-nurse contracts in critical care: a controlled trial.

An experimental trial was conducted to measure the effects of a patient-nurse contract on patients' emotional state during hospitalization in the Coronary Care Unit (CCU). The contractual agreement focused on areas of environmental restrictions and nursing care in the CCU that might decrease patients' sense of control. Forty-one patients with documented coronary heart disease, never previously hospitalized, were randomly assigned to either a control or an experimental group upon admission to the CCU. The control group was oriented to the routines of the unit by one of the nursing staff, while the experimental group made individualized contracts with a nurse regarding family visitation, schedules for daily hygiene, patient teaching, activity and the room environment. A significant difference existed between the two groups over time for the three dependent measures of anxiety, depression and hostility (p less than .001). Twenty-four hours after completing baseline measures, the control group was significantly more anxious (p less than .01) and hostile (p less than .05) than the experimental group. At 48 hours, the experimental group reported significantly lower anxiety (p less than .01), depression (less than .05), and hostility (p less than .05) compared to the control group. These findings suggest that a strategy designed to enhance cardiac patients' sense of personal control may facilitate emotional adaptation to hospitalization.

Adult↗
PubMedDate not supplied

Comparison of survivors and nonsurvivors in pediatric intensive care.

PURPOSE: To identify characteristics of survivors and nonsurvivors among critically ill children admitted to a pediatric intensive care unit. METHOD: A retrospective chart review of 91 children (64 survivors and 27 nonsurvivors) compared age, gender, diagnostic category, and number of days in the ICU. Data were analyzed by Fisher's Exact Test and ANOVA. RESULTS: There were no significant differences among groups. CONCLUSIONS: Data contribute to the development and testing of predictive models for decision-making in pediatric intensive care.

Acute Disease↗
PubMedDate not supplied

Urinary bladder and rectal temperature monitoring during clinical hypothermia.

Three methods of temperature monitoring were studied in 55 adult hypothermic postcardiac surgery patients using the pulmonary artery, rectum, and urinary bladder as measurement sites. Pulmonary artery temperature served as the standard for core body temperature. Measurements in the rectum were recorded with a disposable plastic temperature probe and in the urinary bladder with a thermistor-tipped Foley catheter. Patients were studied within one hour of admission to the cardiac surgical intensive care unit and on an hourly basis until they reached normothermia (37 degrees C). Although mean temperatures did not vary greatly for any group, there was a significant difference between measures over time. Correlations of pulmonary artery and urinary bladder temperatures ranged from .78 to .94, pulmonary artery and rectal temperature from .49 to .82, and urinary bladder and rectal temperature from .46 to .85. The results of this study indicate that the urinary bladder is a reliable indicator of core temperature during rewarming following cardiac surgery.

Adult↗
PubMedDate not supplied

Comparisons of cardiac output in supine and lateral positions.

Cardiac output was measured by thermodilution in 51 adult postcardiac surgical patients using three positions, supine, right lateral, and left lateral, each with 20 degrees backrest elevation. Measurements were taken 4 to 24 hours (M = 10.58) after surgery. Mean cardiac output was significantly different in the three positions, p = .03. This difference resulted from changes in stroke volume, p = .004, rather than changes in heart rate, p = .12. The largest variation occurred between cardiac outputs measured in the supine position and those measured in the left lateral position. Patients at greatest risk for variations in cardiac output with lateral postural change were those with a cardiac index less than 2.3 L/min/m2, those in whom the time elapsed since surgery was less than 12 hours, and those receiving either vasoactive drugs or mechanical ventilation. These results suggest that nurses need to measure cardiac output using a supine position to control for physiological changes that may occur with lateral postural change.

Adult↗
PubMedDate not supplied

Evaluation of a community-based health information service.

The Heart Information Service is a community-based telephone information and referral service designed to provide accurate and current information about cardiovascular disease to the lay and professional publics. In its first two years of existence, trained volunteers responded to more than 11,500 inquiries. The use of the service was evaluated by retrospective analysis of 4,351 calls made over a 12-month period and by a prospective evaluation using mailed survey questionnaires and simulation calls. The data indicate that 78 percent of the callers took at least one positive action as a result of information received. The results suggest that paraprofessional volunteers can effectively provide telephone information about heart disease, its prevention and treatment, as well as offer limited psychosocial support to cardiac patients and their families.

American Heart Association↗
PubMedDate not supplied

Extended comparison of quality of life between stable heart failure patients and heart transplant recipients.

Heart failure has been associated with poor quality of life, which can improve after heart transplantation. Long-term quality-of-life comparisons between patients with heart failure stabilized with medical therapy and heart transplant recipients have not been performed. We assessed quality of life at the time of heart transplantation evaluation and again after 41 months in 12 patients with advanced heart failure stabilized with medical therapy and in 19 patients who had gone on to undergo heart transplantation. Quality of life was measured by three questionnaires. Both groups had similar quality-of-life and clinical features during the transplantation evaluation. Over time, feelings of anxiety and depression, psychologic adaptation, and perceived functional capability improved in the transplant recipients. However, transplant recipients reported more weakness after surgery; this was the major symptom that limited activities. At follow-up 41 months later, we found no significant differences in quality-of-life changes over time between patients stabilized with medical therapy and heart transplant recipients. Overall quality of life for patients who remain stable while receiving medical therapy may not be significantly different from patients who have undergone transplantation.

Aged↗
PubMedDate not supplied

Retention and use of cardiopulmonary resuscitation skills in parents of infants at risk for cardiopulmonary arrest.

Policies of most neonatal intensive care units include teaching cardiopulmonary resuscitation (CPR) to parents or other caretakers prior to infant hospital discharge. However, little is known about CPR skills retention in this population or the outcome of parents' use of CPR. This is a study to measure CPR skills 6 months following CPR training to identify characteristics predicting successful performance and to determine if parents used CPR. A sample of 100 parents or related caretakers of infants at risk for an out-of-hospital respiratory or cardiac arrest 6 months following CPR training were asked to demonstrate CPR on an infant mannequin and 94 agreed to participate. Although they were excluded from the study if they had a CPR course within the past 2 years, 37% had taken CPR sometime in the past. Only one third of participants (n = 31, 33%) were able to perform satisfactory CPR. Those who demonstrated satisfactory CPR skills were more likely to have had previous CPR training and to have experienced higher levels of social support at the time of training than those who achieved unsatisfactory CPR performance ratings (p < .05). A logistic regression analysis revealed previous CPR training, social support, and level of anxiety at time of CPR training to be the most important predictors of CPR skills retention. Seven parents reported using CPR to resuscitate their infant who had suffered a respiratory arrest. All seven were successful. CPR skills decay is significant for caregivers of infants at high risk for cardiopulmonary arrest. Parents should be encouraged to review the steps of CPR frequently and to attend refresher classes. A significant proportion of parents of infants hospitalized in the neonatal intensive care unit are called upon to use CPR and are able to use it appropriately.

Adult↗