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Biomedical subjects

D K Dressler

Publications and source records attributed to D K Dressler.

9 recordsLinked to original sources

Economic trends and issues related to heart transplantation.

Heart transplantation continues to be a focal point of discussion pertaining to the allocation of expensive medical resources. Patients and providers currently face multiple challenges related to the financing of transplantation from pretransplant screening to long-term posttransplant care. Managed care continues to have an impact, which will hopefully lead to improved clinical outcomes and lower costs. Nurses remain instrumental as key team members and patient advocates who continue to work toward cost-effective patient management.

Cost Control↗

Heart transplantation: a review.

This article explores current developments and continuing dilemmas in heart transplantation. Statistical trends such as the increased number of candidates and the increased waiting time are described. Recent developments in implantable ventricular assist device technology and the perioperative use of nitric oxide are also highlighted. In addition, advances in patient management from pretransplant care to long-term follow-up are presented, and alternatives to heart transplantation in current use and for the future are explored.

Aftercare↗

Transplantation in end-stage heart failure.

The benefits and limitations of cardiac transplantation as a treatment option are presented. Also discussed are the phases of the transplant process and pertinent nursing interventions. Advances in immunosuppressive drugs and patient management are highlighted, and long-term considerations and possible advances for the future are presented.

Heart Failure↗

Monitoring and prevention of renal dysfunction in cardiac transplant recipients.

Renal dysfunction is a common problem in cardiac transplant recipients who receive the immunosuppressive agent cyclosporine. Elevation in serum creatinine levels and other indicators of renal dysfunction often appear during the first year after transplant. Related problems of hypertension and gout also are common. Specific strategies to minimize the nephrotoxic effects of cyclosporine and other potential insults to renal function can be used by nurses, physicians, and other health team members. Preservation of renal function enhances a patient's overall functional status and improves survival and quality of life for cardiac transplant recipients.

Cyclosporine↗

Heparin therapy.

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Cardiovascular Diseases↗

A new method of autotransfusing blood drained after cardiac surgery.

Ideally, autotransfusion after cardiac surgical procedures should offer the protection of underwater-seal drainage and involve additional cost to the patients only if their blood is reinfused. A technique of returning the patient's postoperatively drained blood that employs these features and that we have found to be safe, simple, and cost-effective is presented.

Adult↗

Extended cardiac support with a portable left ventricular assist system in the home.

Since 1986, the HeartMate left ventricular assist system (LVAS) has been widely used as a bridge to transplantation. Recently, a multicenter study was undertaken to evaluate the safety of allowing patients supported by the vented electric (VE) LVAS to await transplantation at home. Eligible patients progressed from 1 day to 3 day passes, then were discharged from the hospital. Twenty-nine patients at four centers were evaluated for incidence of adverse events and change in quality of life. Mean time of support was 193.7 +/- 138 days (range, 35-504 days). Patients spent a total of 2,922 days at home: 344 1 day passes and 150 3 day passes were issued; 21 patients were discharged from the hospital. There were 15 readmissions to the hospital: 9 for medical reasons and 6 for device related problems. Patients were able to resolve numerous technical problems at home. No deaths occurred outside of the hospital. Two patients returned to full-time employment, and all patients resumed an active lifestyle. Although adverse events occurred, the results of this study appear to demonstrate that patients may safely await transplantation at home while supported by a HeartMate VE-LVAS.

Adolescent↗

Psychosocial effects of cardiac transplantation.

As more cardiac transplant procedures are performed, the psychosocial implications of the procedure can be identified and investigated. The process of cardiac transplant can be viewed as a series of stages and adaptive tasks which begin with the proposal of transplant and progress to successful postoperative adaptation. The suggestion of transplant may evoke feelings of anxiety and ambivalence as patients realize that transplant may be their only option for long-term survival. The evaluation process determines the need for transplant and whether there are circumstances that might limit post-transplant survival. Psychosocial evaluation is important as survival depends in part on the recipient's ability to cope with stressors and comply with a complex medical regimen. This evaluation is not standardized, and research continues to identify reliable predictors of postoperative behavioral and psychiatric complications. The wait for a donor may be the most stressful of all stages as candidates deal with increasing symptoms, increasingly intensive medical management and the fear of a donor will not be found in time. Following successful surgery, heart recipients and their families express feelings of joy and relief. During convalescence, adjustment difficulties may arise in the form of transient depression or body image concerns. After recipients are discharged from the hospital, they must comply with intensive medical follow-up to monitor their health. They continue to be vulnerable to physical, emotional and financial problems.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗