Biomedical subjects
K Dracup
Publications and source records attributed to K Dracup.
Regulations and critical care.
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An open door policy in ICU.
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Effects of a multidimensional cardiopulmonary rehabilitation program on psychosocial function.
The effects of participation in a structured, outpatient cardiac rehabilitation program on psychosocial function after acute myocardial infarction or coronary artery bypass surgery, or both, were evaluated prospectively in 141 patients who were married or living with "a significant other" (89% men, mean [+/- standard deviation] age 63 +/- 9 years old). Forty-one patients who were participants in a 3-month cardiac rehabilitation program were compared with 100 patients who did not participate in a formal program. On average, patients in both groups were well educated, older Caucasians who had minimal cardiac dysfunction (New York Heart Association class I or II). Patients in the 2 groups were not different at baseline in sociodemographic or clinical characteristics or in any of the dependent measures of anxiety, depression, psychosocial adjustment to illness or marital adjustment. Six months after initial testing, patients who attended cardiac rehabilitation were significantly less anxious (F[1,139] = 5.09, p = 0.03), less depressed (F[1,139] = 8.39, p = 0.004), had better psychosocial adjustment (F[1,139] = 5.87, p = 0.02), and were more satisfied with their marriages (F[1,139] = 8.6, p = 0.004) than nonparticipants. The findings support the effectiveness of group cardiac rehabilitation for this subgroup of patients in facilitating their psychosocial recovery after an acute cardiac event.
MCL1 and MCL6 compared to V1 and V6 in distinguishing aberrant supraventricular from ventricular ectopic beats.
Use of V1 and V6 has been suggested for distinguishing aberrant supraventricular from ventricular ectopy. For two decades, "modified" leads MCL1 and MCL6 have been widely used as V1 and V6 substitutes for bedside monitoring, but their use has never been validated. To determine the value of MCL1 and MCL6, 81 morphologically distinct wide QRS ectopic beats were recorded from 46 patients during cardiac electrophysiological study. As determined by the His-bundle electrogram, 31 of the ectopics were aberrant supraventricular, 50 were ventricular. A new criterion, measurement of QRS onset to the predominant peak or nadir of the complex, was valuable in diagnosing wide complexes in MCL6 and V6. An interval of 50 msec or less predicted aberrant supraventricular ectopy; an interval of 70 msec or more predicted ventricular ectopy. There was agreement between the modified and conventional precordial leads regarding which QRS patterns were useful in distinguishing aberrant supraventricular from ventricular ectopy. A greater proportion of wide complexes in MCL1 and V1 exhibited patterns useful in making the diagnosis compared to MCL6 and V6. Using well-established criteria, the proportion of correct diagnoses that was made from individual leads was: MCL1 = 86%, V1 = 85%, MCL6 = 72%, V6 = 67%. The bedside leads (MCL1 and MCL6) were not statistically different in diagnostic accuracy from their conventional lead counterparts (V1 and V6); however, MCL1 and V1 were superior to MCL6 and V6. When the new criterion was added to make the diagnosis from MCL6 and V6, no difference in diagnostic accuracy was present between the four leads.
Different perspectives: the effect of heart disease on patients and spouses.
Nurses working in critical care units play an important role in helping patients and their families cope with illness. In this article, heart disease is used as a paradigm for discussion of the coping processes of patients and families as they adapt to an acute event. Patients and spouses demonstrate different but equally important responses that may increase marital conflict and impede recovery. The denial frequently used by patients is in direct contrast to the oversolicitousness demonstrated by spouses. Early assessment of potential family dysfunction is essential in order to plan and implement interventions that promote family coping. In this article, the interventions available to nurses working with families in an acute care setting are reviewed. Interview data from one study of cardiac patients and their spouses is used to illustrate the family dynamics seen in the acute and chronic phase of recovery and to provide examples of the couples' differing perspectives on the helpfulness of various interventions.
Treatment-seeking behavior among those with signs and symptoms of acute myocardial infarction.
Significant delays in seeking definitive treatment for the signs and symptoms of acute myocardial infarction increase morbidity and mortality. In most studies, delay times average more than 4 hours. The following variables are associated with increased delay: a medical history of angina, diabetes mellitus, or hypertension; older age; black race; seeking advice from a family member or a physician; symptom onset on a weekday; and attempts at self-treatment. Variables associated with reduced delay times are the following: pain recognized as cardiac in origin, hemodynamic instability, severe chest pain, younger age, and consultation with a coworker. Surprisingly, patients who have already experienced a myocardial infarction are just as likely to delay as patients who have not had this experience. These findings provide direction for developing and testing patient and family interventions, establishing community education programs, and reducing patient delay in response to the signs and symptoms of acute myocardial infarction.
Cardiopulmonary resuscitation skills retention in family members of cardiac patients.
The purpose of this study was to determine if the use of a retention strategy would maintain cardiopulmonary resuscitation (CPR) skills in family members of cardiac patients. Thirty-one subjects trained in CPR received retention packets 3 and 6 months after CPR training. Sixteen subjects were tested for CPR retention at 7 months after initial training, and 15 at 12 months. Likelihood chi 2 was used to compare the 7- and 12-month groups. There were no differences between the 7- and 12-month groups, because CPR retention overall was poor. Only 19.4% of subjects reported using the retention packet; therefore, subjects were regrouped into practice and no practice groups for purposes of further statistical analysis. There were significant differences in retention in subjects who practiced compared with subjects who did not. These findings underscore the importance of promoting practice/review after initial CPR training for family members of cardiac patients.
Serum prolactin concentrations in patients with the acquired immunodeficiency syndrome.
Experimental evidence suggests that prolactin is an important immunomodulator hormone. Because this endocrine-immune link may represent a potential new therapeutic avenue, we considered its application in states of immunodeficiency. We hypothesized that serum prolactin concentrations might be abnormal in AIDS. To test this hypothesis, we measured serum prolactin concentrations in blood samples obtained from patients who had either AIDS (n = 15) or AIDS-related complex (n = 12), asymptomatic subjects who were antibody-positive for human immunodeficiency virus (HIV) (n = 10), HIV antibody-negative homosexual subjects (n = 10), and heterosexual HIV antibody-negative controls (n = 21). We found no difference in the serum prolactin concentrations between the five subject groups. We conclude that circulating prolactin values are not altered by HIV infection; however, the possibility that prolactin administration may modulate immune function remains to be tested.
Psychosocial adjustment of patients with ventricular dysrhythmias.
This study was conducted to document whether differences in psychosocial adjustment exist between cardiac arrest survivors and patients with recurrent ventricular dysrhythmias and to identify specific patient characteristics associated with psychosocial adjustment in those individuals who have experienced ventricular dysrhythmias with or without cardiac arrest. Nineteen cardiac arrest survivors and 21 ventricular dysrhythmia patients participated in the study. There was no significant difference in psychosocial adjustment between the two groups. The characteristics that were found to be predictive of psychosocial adjustment in patients with ventricular dysrhythmias were marital status, number of dysrhythmic events, and history of heart failure.
Readers respond with ideas for improving diagnostic abilities.
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Withholding and withdrawing mechanical ventilation: assessing quality of life.
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Heart transplantation may not improve quality of life for patients with stable heart failure.
Heart transplantation is a therapeutic option for many patients with end-stage heart failure. Vigorous medical therapy has evolved so that many patients eligible for heart transplantation can now be discharged and stabilized with medical therapy. Heart transplantation improves survival, but it has not been compared previously with sustained medical therapy with regard to quality of life. We compared quality of life for 24 patients who survived at least 6 months after heart transplantation with that for 20 patients clinically similar at baseline who survived at least 6 months with sustained medical therapy. Quality of life was assessed by using three questionnaires. Both groups were similar in psychosocial functioning, with patients receiving medical therapy reporting greater dysfunction in social activities, as compared with those who underwent heart transplantation. No differences were seen in 6-minute walking distances and employment status. Survival benefits are expected with heart transplantation; however, quality of life for survivors may not be different than that for patients who survive with sustained medical therapy.
How well do CCU patient-nurse contracts work?
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Can family members of high-risk cardiac patients learn cardiopulmonary resuscitation?
The immediate delivery of bystander-administered cardiopulmonary resuscitation (CPR), coupled with the rapid delivery of advanced cardiac life support, can significantly reduce mortality from out-of-hospital cardiac arrest. Because the majority of sudden cardiac deaths occur in the victim's home with family members present, family members of cardiac patients at high risk for sudden death are the logical focus of CPR training. However, previous research has shown that only a small minority of family members of cardiac patients actually learn CPR and that health care professionals have failed to recommend CPR training in this population, in part due to concerns about their ability to learn CPR. The purpose of this study was to describe learning capabilities in this population and to identify characteristics of unsuccessful learners. To this end, we taught CPR to 83 family members of cardiac patients who were at risk for sudden cardiac death. Subjects had no CPR training within the past two years. Eighty-one percent of the subjects successfully learned CPR. Of the demographic and psychological characteristics examined, only gender, age, and depression were significant in explaining differences in CPR skills attainment ability. The elderly, the depressed, and males were more likely to be unsuccessful in demonstrating adequate CPR skills. Our results suggest that the majority of family members of cardiac patients can learn CPR successfully. Specific training strategies may need to be developed and tested to enhance CPR training in those family members of cardiac patients predicted to have difficulty learning CPR.
Adult cardiology and the expanding supply of physicians.
The number of cardiologists can be projected with considerable accuracy into the next century. The total cardiology pool of physicians will increase until the year 2015 at which time those entering and leaving the pool will come into equilibrium. At that time the ratio of active cardiologists to the population will have greatly increased. This nation's future need for cardiologists is difficult to assess with any degree of precision. Therefore, this is the time for updating practice profile studies. Such studies today could be formulated in a manner to provide more detailed information on the cardiologist's daily activities. In addition, a data base developed through methodology such as the consensus formation approach must be developed and updated on a periodic basis. Through such analyses it will be possible to quantitate the future needs of cardiovascular manpower.
Are critical care units hazardous to health?
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Integration of nursing diagnoses in the critical care nursing literature.
It has been almost 15 years since the start of the nursing diagnosis movement. Consensus development, research, and infiltration have been slow but progressive. However, integration of nursing diagnoses into the critical care literature has not progressed as much as have other components of the movement. All three nursing diagnosis activities are interdependent, and without infiltration the whole process is slowed. We believe that the process of infiltration through the literature could be greatly accelerated if the recommendations presented here were implemented. This increasing infiltration of nursing diagnoses through the literature would then have a positive effect on all other concurrent activities involved in the nursing diagnosis movement.