PubMed · 12640792
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Leona Armstrong. Clot busters.. https://pubmed.ncbi.nlm.nih.gov/12640792/
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Severe primary mitral regurgitation (MR) has a poor outcome if left uncorrected. Successful mitral valve repair has the unique potential to restore normal life expectancy and is superior to valve replacement. Despite this, mitral repair is performed relatively infrequently and many patients with potentially reparable valves have a replacement instead, subjecting them to unnecessary risk. Surgery in asymptomatic patients is a particularly difficult issue with some units advocating surgery irrespective of symptoms, based purely on the severity of regurgitation. This strategy cannot be widely adopted with the current patchy provision of high-quality valve repair surgery. Misplaced enthusiasm for early operation runs the risk of a failed repair and the hazards of a mechanical prosthesis. To ensure optimal treatment for patients with MR, cardiologists must be aware of the indications for valve repair and ensure that patients with potentially reparable valves are referred to surgeons with proven expertise, even if this means a shift from established practice. Surgical units need to promote subspecialization and rigorously audit their outcomes. There are currently no agreed standards for best practice in mitral valve repair and this is an area where professional societies may wish to take a role.
BACKGROUND: Over the last three decades, nurse theorists have strongly advocated the use of conceptual models of nursing to guide nursing practice. Within coronary care units, conceptual model-based care has had inconsistent application and is currently challenged by contemporary approaches such as pathways of care. AIMS: This paper aims to critically analyze the use of Orem's self-care deficit nursing theory as a modus operandi to effectively meet the needs of hospitalized patients in coronary care. RESULTS: Although complex both in the language and construction, the self-care model , provides a comprehensive and holistic approach to the care of people in coronary care. CONCLUSIONS: This paper highlights the potential contribution the application of the self-care deficit nursing theory to the coronary care setting from a philosophical and practical perspective. Orem's conceptual model of nursing and current practice in coronary care units share certain similarities that render a useful model for use in practice. However, while it is recommended for consideration for use in both practice and educational settings, further empirical work is required in the area, together with realistic and practical application of the theory to practice in a way that embraces contemporary notions.
BACKGROUND: Environmental factors have been implicated as major causes of sleep disruption in patients in critical care units, including coronary care units (CCU). We hypothesized that myocardial infarction may disturb sleep architecture regardless of the surrounding environmental factors. MATERIAL/METHODS: Twenty consecutive patients with a first-ever acute myocardial infarction (AMI) who were not on sedation or ionotropes underwent a full polysomnography (PSG) in our sleep disorders center, away from the CCU environment, within three days of AMI, with a follow-up PSG performed six months later. During patient stay in the CCU, each resided in a single room in which normal light-dark exposure was maintained. RESULTS: The 20 patients with AMI consisted of 18 males and 2 females, of a mean +/-SE age of 51.1+/-1.7 years. Compared with the follow-up PSG, the initial PSG revealed significant increases in arousal index, spontaneous arousal index, wake time, and REM latency and significant reductions in sleep efficiency and REM sleep. CONCLUSIONS: Patients with AMI have altered sleep architecture, despite controlling for common sleep-disrupting environmental factors. Future research should explore other possible etiologies of sleep disruption in patients with AMI, including the underlying infarction itself and its associated physiological and inflammatory changes.