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Biomedical subjects

J Muirhead

Publications and source records attributed to J Muirhead.

13 recordsLinked to original sources
PubMed1995

Positive expectations predict health after heart transplantation.

We explored the relations between positive expectations and adjustment, adherence, and health in cardiac transplant patients. Thirty-one patients and their nurse completed questionnaires before transplantation and at 3 times after surgery. As predicted, patients' self-reported positive expectations were generally associated with good mood, adjustment to the illness, and quality of life, even in patients who experienced health setbacks. High preoperative expectations predicted later adherence to a complex medical regimen. Positive expectations measured before the transplant predicted a substantial amount of the variance in the nurse's ratings of physical health 6 months after surgery, covarying for adherence behavior and preoperative health.

Adaptation, Psychological↗
PubMed1995

Scratching the surface: mental health training for rural health workers.

This paper will describe the Mental Health Training for Rural Health Workers Project that was completed in 1995 under the Rural Health Support Education and Training Program. The lack of specialist mental health services in rural areas means that generalist health workers need to provide mental health services in rural communities. Generalist health workers often feel ill-equipped to help people who require mental health services. The aim of this project was to provide generalist workers in rural areas with practical skills and knowledge in order to help people with mental health disorders and promote positive mental health. The project involved an initial needs survey, the development of education and training material, the implementation of the training, and evaluation of the project.

Clinical Competence↗
PubMed1992

Heart transplantation in children: indications, complications, and management considerations.

Heart transplantation in children has increased in the last 5 years because of the availability of cyclosporine and improved surgical techniques. The primary indications for transplantation in children are dilated cardiomyopathy and complex congenital heart disease. The major complications affecting morbidity and mortality are infection and rejection. However, the development of accelerated coronary artery disease represents a serious complication limiting long-term survival. Successful rehabilitation and long-term survival depend on careful selection of potential recipients, application of stringent medical and psychosocial criteria, operative technique, comprehensive medical surveillance, and thorough and effective patient and family education.

Adolescent↗
PubMed1992

Heart and heart-lung transplantation.

The fields of heart and combined heart-lung transplantation are in a constant state of evolution. As greater experience is gained in posttransplant management, more patients with end-stage heart and lung disease can be treated. Because the postoperative course and rehabilitation phase may be extremely difficult, only candidates who meet specific medical and psychosocial criteria are selected. During the waiting period, critical care nurses along with the transplant team are instrumental in stabilizing the emotional and physical condition of the transplant candidate. Postoperative complications requiring intensive therapy include decreased cardiac output, respiratory dysfunction, rejection, and infection. Graft atherosclerosis, obliterative bronchiolitis, and malignancy are long-term complications that may limit survival. Life-long immunosuppression and careful long-term medical surveillance are crucial to the health of the recipient. Although there are numerous emotional and physical challenges related to potentially life-threatening complications and other disturbances in daily living, the quality of life for most recipients has greatly improved.

Heart Transplantation↗
PubMed1991

Chronic hyperplastic candidosis and secretor status.

A prospective study was undertaken of 22 patients with chronic hyperplastic candidosis and 50 age and sex matched individuals with no evidence of oral mucosal disease. Specifically the relationship between the inherited ability to secrete blood group antigens in saliva and chronic hyperplastic candidosis was investigated. The proportion of non-secretors of blood group antigens was significantly higher in patients with chronic hyperplastic candidosis (68%) compared to the control subjects (38%). The inability to secrete blood group antigens in saliva may therefore be a risk factor in the development of, or persistence of chronic hyperplastic candidosis.

ABO Blood-Group System↗
PubMed1989

Heart and heart-lung transplantation.

The fields of heart and combined heart-lung transplantation continue to evolve, allowing treatment of more individuals with end-stage heart and lung disease. The postoperative course and rehabilitation phase may be arduous, emphasizing the importance of selecting candidates who meet specific medical and psychosocial criteria. Life-long immunosuppression and meticulous long-term medical surveillance are mandatory practices to promote the health of the recipient. The major complications that contribute to morbidity and mortality, especially during the first post-transplant year, are infection and rejection. Graft atherosclerosis, obliterative bronchiolitis, and malignancy are long-term complications that may limit survival. In spite of the emotional and physical challenges related to potentially life-threatening complications and other disturbances in daily living, the quality of life for most recipients has markedly improved.

Heart Transplantation↗
PubMed1984

Perioperative beta blockade with propranolol: reduction in myocardial oxygen demands and incidence of atrial and ventricular arrhythmias.

To determine the effect of beta blockade with propranolol on myocardial oxygen demands and postoperative arrhythmias in patients having coronary bypass operations, 50 patients with chronic stable angina undergoing operation were randomized in a double-blind fashion to receive either propranolol (60 mg every 6 hours) or a placebo. Drug administration began 24 to 48 hours prior to operation and continued through the operative period and for one month after operation. There were no deaths. Two perioperative myocardial infarctions occurred, both in patients receiving a placebo. Myocardial oxygen demand as measured by the rate-pressure product (heart rate X mean arterial pressure) was significantly reduced during induction of anesthesia (7,658 +/- 451 versus 5,786 +/- 340; p less than 0.002) and during sternotomy (8,400 +/- 550 versus 6,756 +/- 384; p less than 0.02) in propranolol-treated patients. In the first two postoperative days, nitroprusside was required for control of hypertension of 10 patients in the placebo group but in only 3 patients given propranolol (p less than 0.05). Postoperatively, 15 of the 26 patients who received a placebo had 45 episodes of arrhythmia. Seven of the 24 propranolol-treated patients had 17 episodes (p less than 0.04). We conclude that propranolol given perioperatively in doses large enough to induce beta blockade significantly reduces myocardial oxygen demands in the vulnerable period during induction of anesthesia and sternotomy, reduces the need for antihypertensive therapy in the immediate postoperative period, and causes a marked reduction in the incidence and frequency of both supraventricular and ventricular arrhythmias in the postoperative period.

Angina Pectoris↗
PubMed1982

Repair of atrioventricular canal malformation in the first year of life.

Disappointing results with pulmonary artery banding and subsequent correction led to the decision in 1977 that all infants presenting to our hospital with atrioventricular (AV) canal and evidence of severe heart failure, lack of growth, or pulmonary hypertension should have early operative correction. Since that time 24 consecutive infants have undergone repair. All had refractory heart failure. Average age at operation was 18 weeks (3 to 38) and average weight was 4.3 kg (2.3 to 6.4). Only four patients were older than 6 months of age at operation. Preoperative peak pulmonary artery pressure was 81 +/- 3.3 mm Hg, which was equal to systemic arterial pressure in all cases. Mean pulmonary-to-systemic resistance ratio was 0.28 +/- 0.05. five patients had moderate mitral regurgitation and five had a ductus arteriosus. Three had significant associated malformations. Profound hypothermia and circulatory arrest were utilized in all patients. Common AV valve tissue was divided and valvular integrity was ensured by resuspension to a single Dacron patch which closed both the atrial and ventricular defects. Operative death occurred in two patients (8%) both with associated defects (one with total anomalous pulmonary venous connection and the other with coarctation). One late death occurred in a patient with associated partial anomalous pulmonary venous connection, and one patient has had a pacemaker implanted. Survivors have been followed for 7 to 60 months. All patients are growing at an increased rate postoperatively. All cardiac medications have been discontinued in 16 of 21 patients. Operative repair of complete atrioventricular canal can be performed in infancy with low operative and late death rates and will relieve signs and symptoms of heart failure and allow more normal growth and development. On the basis of this experience, it appears unnecessary to delay operative correction with the known increased risk of the development of pulmonary hypertension.

Blood Pressure↗
PubMedDate not supplied

Quality of life and coping in patients awaiting heart transplantation.

The psychosocial adaptation of patients awaiting heart transplantation has not been defined. Forty-one patients (36 men, 5 women; mean age, 48 years) completed standardized questionnaires before transplantation to assess quality of life, physical symptoms, marital/social adjustment, psychiatric morbidity, coping, and compliance to medical regimens. Also, data were obtained from spouses/partners and the transplantation nurse coordinator. Unlike previously reported findings with patients after transplantation, those awaiting transplantation report moderate dissatisfaction with quality of life. Patients report physical symptoms, functional disabilities, sexual dysfunction, and psychological distress. Nonetheless, reported levels of compliance with the medical regimens and of social support were high, and both patients and spouses/partners provided marital adjustment ratings on the Dyadic Adjustment Scale that were comparable to those of well-adjusted, happily married couples. High levels of coping also were recorded. Having a positive attitude and seeking social support were the most common coping strategies, whereas confrontation, acceptance, and escapism were relatively uncommon. In conclusion, patients awaiting heart transplantation, although dissatisfied with quality of life, maintain positive psychological and social adjustment.

Adaptation, Psychological↗