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Biomedical subjects

E Feleke

Publications and source records attributed to E Feleke.

11 recordsLinked to original sources
PubMed1999

Intensive rehabilitation of emotionally distressed patients after coronary by-pass grafting.

OBJECTIVES: To evaluate whether the status of emotionally distressed post coronary by-pass surgery patients can be improved by a comprehensive, in-patient rehabilitation programme. DESIGN: Cross-sectional. SETTING: Rehabilitation hospital. SUBJECTS: One hundred and fifty-two post coronary by-pass surgery patients referred to an intensive rehabilitation programme. The study group was divided into two subgroups, according to the level of emotional distress. Forty-three (30%) out of 142 patients who completed the Nottingham Health Profile were considered to be distressed. INTERVENTIONS: The comprehensive 4-week inpatient rehabilitation programme consisted of daily physical exercise, lectures about coronary disease and risk factors, psychological support and nutrition counselling. MAIN OUTCOME MEASURES: Physical fitness, blood lipids and quality of life questionnaires. RESULTS: The two-way analysis of variance showed that emotionally distressed patients achieved equally good results as those obtained by nondistressed patients in performance regarding the maximal exercise stress test, maximum rate pressure product achieved, or the level of resting heart rate. Significant improvement in psychological well-being as assessed by a seven-point rating scale was observed in both groups. Both groups of patients were also equally successful in weight reduction and lowering of total cholesterol and triglycerides. Of all the patients who were employed at admission, twice the number of patients in the distressed group were in receipt of a permanent disability pension and half the number of patients was employed, compared to the initially nondistressed group, at 1-year follow-up. CONCLUSIONS: Distressed patients were very successful in improving their functional status and reducing risk factors when offered an intensive rehabilitation programme but they were much less successful in returning to work. Secondly, patients who were emotionally distressed after surgery did not differ in regard to disease status or physical capacity from nondistressed patients. They did, however, experience more angina pectoris both in daily life and when exposed to a maximal exercise stress test. Finally, the presence of emotional distress was easily detected by any measure of psychological status.

Adult↗
PubMed1999

Patient-perceived quality of life after coronary bypass surgery. Experienced problems and reactions to supportive care one year after the operation.

In an interview conducted one year after coronary bypass surgery (CABG), 115 patients (92 males, 23 females) were asked to discuss their present quality of life, problems related to the operation and their reactions to the supportive care following the operation. The main purpose of this study was to assess whether the patients' own presentation of these questions revealed information not elucidated through a standard questionnaire which included the Nottingham Health Profile and other questions on physical, emotional and social well-being. About one quarter of the interviewed patients expressed dissatisfaction concerning their present quality of life, information which corresponded well with the findings in the questionnaires. Reported limitation in physical activity did not, however, match exercise test findings. The interviews alone revealed additional information concerning well-being. Most important were problems with wound healing and difficulties describing and interpreting pain and other discomfort in the thoracic area. Several patients also expressed dissatisfaction with the postoperative supportive care. We conclude that there is a need for a complementary approach to estimate quality of life, and that this could be included in an extended nursing care program designed to meet the varying needs of patients after CABG.

Activities of Daily Living↗
PubMed1998

Emotional distress before coronary bypass grafting limits the benefits of surgery.

BACKGROUND: The inclusion of large, heterogeneous groups of patients for coronary bypass grafting (CABG) surgery has resulted in a more mixed treatment outcome. Thus it becomes important to identify patients who are less likely to benefit from surgery or who may require additional support to improve treatment outcome. The aim of the present study was to examine whether psychological status measured before CABG can contribute to prediction of short- and long-term outcomes of the surgery. METHODS AND RESULTS: One hundred seventy-one consecutive patients from two large university hospitals in Stockholm completed a psychosocial questionnaire before being scheduled for surgery. One year after CABG, patients again completed the questionnaire. Follow-up of medical charts was conducted during the first 3 years after surgery. All major cardiac events (cardiac death, definite myocardial infarction, revascularization, and unstable angina verified by angiography or myocardial scintigraphy) were recorded. Although the overall effect of surgery was excellent in the majority of cases, the patients exhibiting a high degree of distress (anxiety, depression, and tiredness) before surgery assessed their status as being much worse both before the operation and at the 1-year follow-up. Equally important was the fact that patients considered distressed before surgery had significantly higher rates of cardiac events (16%) in the 3-year follow-up period compared with nondistressed patients (5%) (chi-square=5.11, degrees of freedom=1, p < 0.02). CONCLUSIONS: Systematic evaluation and treatment of emotional distress in the candidates for coronary revascularization may be expected to result in more optimal subjective results and a reduction in the number of serious cardiac events after surgery.

Adult↗
PubMed1998

State anxiety predicts poor psychosocial outcome after coronary bypass surgery.

A prospective study was conducted to identify predictors of poor psychosocial adjustment 1 year after coronary bypass graft (CABG) surgery. Fifty-two of 61 consecutive patients (mean age = 66 +/- 9, 3 years, 76% men) were studied before and 1 year after surgery. Psychological, social, and surgical data were assessed. The roles of State and Trait anxiety, emotional reactions, and different coping modes were evaluated. At baseline the patients were divided into 3 groups according to their level of anxiety as assessed by Spielberger's State Anxiety Inventory (STAI). The 3 groups did not differ in any of the basic parameters, except for their subjective experience of symptoms of dyspnoea (p < .01), and quality of life (p < .0001) for the whole patient group 1 year after surgery. However, patients belonging to the moderate-anxiety and high-anxiety groups remained more psychologically distressed (p < .0001) and perceived a higher degree of residual angina pectoris (p < .0001) than did patients who did not display anxiety preoperatively. Dividing the patients into groups according to their answers to the other measures of psychological distress or negative coping strategies yielded similar results. The results indicate that the SATI is a valuable instrument for identifying risk patients for poor adjustment after CABG surgery.

Journal Article↗
PubMed1989

Computer-detected ventricular tachycardia in the coronary care unit: prognosis in patients with and without acute myocardial infarction.

Survival (for up to 6 years) in coronary care unit (CCU) patients with ventricular tachycardia (VT) was studied with the aid of an automated arrhythmia monitoring system. Ventricular tachycardia was defined as four or more consecutive ventricular beats with a rate above 120 per min. During an 18-month period. VT was observed in 102 individuals (13%) out of 800 patients without acute myocardial infarction (AMI). The 102 patients were compared with age- and sex-matched patients with AMI and VT and a group with AMI but without VT. Hospital mortality was 27% in patients with AMI and VT, 23% in patients with AMI without VT, and 16% in non-AMI patients with VT (NS). First year mortality after discharge was 20% in the non-AMI group compared to 12% in the AMI groups (NS). The 1-6 years survival curves also did not differ significantly between the groups with a yearly mortality of between 5 and 6%. Acute myocardial infarction patients with rapid VT (greater than 150 min-1) or long VT (more than 10 beats) had a higher hospital mortality, otherwise the number or type of VT episodes did not relate to short- or long-term prognosis in the studied groups. Ventricular tachycardia in the CCU did not seem to be an indicator of poor long-term prognosis. It is concluded that long-term prognosis in patients with VT in the CCU was little influenced by a current diagnosis of AMI.

Aged↗
PubMed1985

Long term experience of felodipine in combination with beta-blockade and diuretics in refractory hypertension.

Felodipine, a new dihydropyridine, was given to 58 hypertensive patients in combination with an adrenergic beta-receptor antagonist and a diuretic agent. In all but 2 patients the blood pressure was unsatisfactorily controlled on standard triple therapy, i.e. alpha beta-blocker, a diuretic and a vasodilator. A 48-week follow-up was completed by 54 patients. After an initial dose titration period, the maintenance dose of felodipine was 5 mg twice daily in 14 patients and 10 mg twice daily in 34 patients. In the remaining 6 patients, the dose ranged from 5 mg every morning to 25 mg twice daily. The dosages of beta-blocking agent and diuretic were considerably reduced during the study period. Mean supine blood pressure was reduced from 170/101 mm Hg on triple therapy before felodipine to 145/86 mm Hg (p less than 0.001) after 2 weeks on felodipine. This improvement was sustained throughout the study and was measured at 144/86 mm Hg (p less than 0.001) after 48 weeks. There was no increase in resting heart rate and no orthostatic fall in blood pressure. Bodyweight was not increased and felodipine was generally well tolerated. Three patients were withdrawn owing to side effects and 1 was socially non-compliant. It is concluded that felodipine is a potent and well tolerated vasodilator, and will be useful in the long term combination treatment of previously refractory hypertension.

Adrenergic beta-Antagonists↗
PubMed1983

Complaints of cold extremities among patients on antihypertensive treatment.

A total of 758 consecutive patients attending three hypertension clinics answered a questionnaire designed to assess the prevalence and severity of complaints of cold extremities among patients on various antihypertensive drugs. Forty-four per cent claimed to have had complaints of cold extremities and about 50% of these had had symptoms already prior to antihypertensive treatment. Among the newly symptomatic patients the prevalence of symptoms was 18% of those on diuretics and 40% of those on beta-blockers (p less than 0.01). No significant association was found between the prevalence of symptoms and age, sex, use of vibrating tools, smoking or history of various conditions associated with atherosclerosis. No significant difference was found in the prevalence of symptoms among patients on propranolol, alprenolol, pindolol, atenolol and metoprolol. It is concluded that cold hands and feet are common among hypertensive patients and may be aggravated by treatment with not only beta-blockers but also diuretics.

Adrenergic beta-Antagonists↗