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1.

Background

Experience of myocardial infarction (MI) negatively affects different aspects of health-related quality of life (HRQoL).

Objectives

This study aimed to examine trends in HRQoL of MI patients and to identify demographic, clinical and psychosocial predictors of HRQoL at three months.

Methods

A total of 150 patients in South Korea were completed the study questionnaires at baseline. After three months from discharge, 136 participants completed follow-up questionnaires, including the Korean version of the MacNew Quality of Life after Myocardial Infarction Questionnaire (MacNew).

Results

HRQoL significantly improved over three months. Younger age, ST-elevation MI, and higher LVEF, lower level of depression, better understanding of the illness and higher perceived social support at baseline were associated with better HRQoL at three months.

Conclusion

Providing adequate information about the illness and social support as well as reducing negative psychological experiences in early days after MI may improve HRQoL of MI patients.  相似文献   

2.

Background

In developing countries, the number of adults who develop myocardial infarction (MI) at a young age is high. The popularity of waterpipe smoking (WPS) has increased among the same age group. It is unknown if WPS contributes to the incidence of early-onset MI.

Objective

To study the association of WPS with early-onset MI, which is defined as first MI occurring in individuals 18 ≥ age ≤ 45 years compared to those older than 45 years.

Methods

This was a cross-sectional study. The association of WPS with first-time MI was compared between younger and older adults (N = 225).

Results

Twenty-five percent of all participants developed an acute MI before the age of 46 years. Both cigarette and WPS were more common among younger first-time MI patients than older first-time MI patients.

Conclusions

WPS is one risk factor that distinguishes the risk profile of young adults with early-onset MI.  相似文献   

3.

Background

Stress cardiomyopathy is a transient cardiac syndrome characterized by reversible left ventricular systolic dysfunction precipitated by emotional or physiologic stress. The presence of obstructive coronary artery disease has been noted in stress cardiomyopathy.

Methods

We describe 3 case reports of patients with acute coronary syndrome and transient wall motion abnormalities not usually seen in the distribution of coronary artery disease.

Results

In these 3 cases of acute myocardial infarction, the distribution of the culprit coronary occlusion was not concordant with the territory of transient wall motion abnormality. Follow-up demonstrated resolution of the wall motion abnormalities without intervention in these territories.

Conclusion

We believe that the physiologic stress of the acute coronary syndrome may have precipitated the stress cardiomyopathy as presented by these patients. This is the first demonstration that stress cardiomyopathy may be precipitated by acute coronary syndrome.  相似文献   

4.

Background

Adequate strategies using either transthoracic (TTE) or transesophageal (TEE) echocardiography in patients receiving cardiopulmonary resuscitation (CPR) is an ongoing area of research.

Objectives

As transthoracic point-of-care ultrasound (POCUS) during cardiac arrest resuscitation might result in an increased duration of interruptions in the delivery of chest compressions; the use of TEE has been proposed as an alternative.

Methods

No technical complications of either TTE nor TEE are so far being reported in the literature.

Results

We report the case of a left intramural atrial hematoma complicating TEE procedure during cardiac arrest. This highlights a unique and to our knowledge, first-in-man, described complicating TEE procedure during CPR.

Conclusions

Further research on the safety of transesophageal echo during CRP is mandatory and the question about any potential harm of particular interest.  相似文献   

5.

Introduction

This study compared inpatient outcomes related to the use of these two devices among patients who developed cardiogenic shock not due to acute myocardial infarction or coronary revascularization.

Methods

We extracted admission-level records of patients with a diagnosis of cardiogenic shock who underwent either PVAD or IABP implantation from the National Inpatient Sample (NIS) database from 2010 to 2014. Our outcomes of interest were mortality and length of stay.

Results

Inpatient mortality was significantly higher in the PVAD cohort. In multivariate analysis, PVAD use in these patients was associated with higher mortality. There was no difference in the length of stay between both groups among patients that survived to discharge.

Conclusion

In our analysis of the NIS database, the use of PVADs in patients with cardiogenic shock of non-ischemic origin was associated with higher mortality when compared to IABP use.  相似文献   

6.

Background

A 71-year-old non-smoking female with a history of diabetes, hypertension, hyperlipidemia and end-stage renal disease presented to the emergency department for right leg pain due to an ankle fracture.

Case

The patient's initial electrocardiogram (ECG) revealed ST segment elevations in the anterior leads. She denied any chest pain, shortness of breath, fatigue, lightheadedness, palpitations, nausea or diaphoresis. Her initial laboratory Troponin I resulted 35.9 ng/mL. Coronary catheterization demonstrated 99% occlusion of the left anterior descending (LAD) coronary artery. The patient had 2 drug eluting stents placed in the LAD with 10% residual stenosis.

Conclusion

Although witnessing an ongoing asymptomatic ST elevation myocardial infarction (STEMI) is rare, this case highlights the importance of early revascularization when the ECG demonstrates a STEMI, even in the absence of symptoms for patients at risk for silent myocardial infarctions.  相似文献   

7.

Background

Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is increasingly utilized in the management of severe acute respiratory distress syndrome (ARDS). Providers who care for patients on VV-ECMO should be familiar with common circuit complications.

Objectives

To provide an example of a common complication, circuit “chugging,” and suggest a management algorithm which aims to avoid excessive fluid administration to patients with ARDS.

Methods

We use a clinical case to illustrate chugging and discuss potential management strategies.

Results

Our patient received frequent boluses of albumin for intermittent circuit chugging contributing to a net positive fluid balance of roughly 6 liters 4 days after cannulation.

Conclusions

Chugging is a common complication for patients on VV ECMO. A thoughtful approach to management may help limit potentially harmful fluid administration for patients with ARDS.  相似文献   

8.

Rationale

Consensus recommendations have been developed to guide exercise rehabilitation of mechanically ventilated patients in the intensive care unit.

Objective

This study aimed to investigate the safety of exercise rehabilitation of mechanically ventilated patients and evaluate the consensus recommendations.

Methods

This was a prospective, single-centre, cohort study conducted in a specialist cardiothoracic intensive care unit of a tertiary, university affiliated hospital in Australia.

Results

91 mechanically ventilated participants; 54 (59.3%) male; mean age of 56.52 (16.3) years; were studied with 809 occasions of service recorded. Ten (0.0182%) minor adverse events were recorded, with only one adverse event occurring when a patient was receiving moderate level of vasoactive support.

Conclusions

The consensus recommendations are a useful tool in guiding safe exercise rehabilitation of mechanically ventilated patients. Our findings suggest that there is further scope to safely commence exercise rehabilitation in patients receiving vasoactive support.  相似文献   

9.

Background

The aim of this study was to analyze the indications for using bare metal stents (BMSs) in hospitalizations with ST segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI).

Methods

The study cohorts were identified from the National Inpatient Sample database from 2010–2014 using appropriate, International Classification of Diseases, 9th Revision, Clinical Modification, diagnostic and procedural codes.

Results

A total of 123,487 hospitalizations were identified for this study. Drug eluting stent (DES) use demonstrated lower in-hospital mortality (5.8% vs. 3.3%, P = < 0.01) and other in-hospital outcomes, thus resulting in lower hospitalization stay. Higher age, black race, greater comorbidity burden, inferior wall myocardial infarction, and the use of mechanical circulatory devices were all associated with BMS use.

Conclusion

DES was the preferred standard of care in the era of 2nd generation DES; however, BMSs were used in hospitalizations with high-risk procedures and multiple risk factors.  相似文献   

10.

Background

Chronic obstructive pulmonary disease (COPD) patients experience multiple symptoms including dyspnea, anxiety, depression, and fatigue, which are highly correlated with each other. Together, those symptoms may contribute to impaired physical performance.

Objectives

The purpose of this study was to examine interrelationships among dyspnea, anxiety, depressive symptoms, and fatigue as contributing factors to physical performance in COPD.

Methods

This study used baseline data of 282 COPD patients from a longitudinal observational study to explore the relationship between depression, inflammation, and functional status. Data analyses included confirmatory factor analyses and structural equation modeling.

Results

Dyspnea, anxiety and depression had direct effects on fatigue, and both dyspnea and anxiety had direct effects on physical performance. Higher levels of dyspnea were significantly associated with impaired physical performance whereas higher levels of anxiety were significantly associated with enhanced physical performance.

Conclusion

Dyspnea was the strongest predictor of impaired physical performance in patients with COPD.  相似文献   

11.

Objectives

To explore whether five variables of the health belief model were factors influencing self-care behaviors in young and middle-aged adults with hypertension.

Background

The self-care behaviors of young and middle-aged adults with hypertension are suboptimal in China, and the factors associated with self-care behaviors have rarely been studied in the population.

Methods

A questionnaire survey was adopted in the study. 382 eligible participants were recruited from two tertiary teaching hospitals using the convenience sampling.

Results

The predictors of self-care behaviors in young and middle-aged adults with hypertension included age, complications related to hypertension, perceived susceptibility, severity, benefits, barriers and self-efficacy. Five aspects of health beliefs model accounted for 47.0% of total variance.

Conclusions

The perceived susceptibility, severity, benefits, barriers, and self-efficacy were key factors affecting self-care behaviors in young and middle-aged adults with hypertension. A health education program targeting improving health beliefs for the population should be developed.  相似文献   

12.

Objective

To explore the decision making processes undertaken by community-dwelling individuals with heart failure as they experience symptom changes.

Background

Heart failure patients are responsible for daily self-management that includes responding to symptom fluctuations between exacerbations. Despite education, some patients fail to seek timely medical intervention when symptoms change.

Methods

Semi-structured interviews were conducted with homecare patients after receiving self-management education. Grounded theory methods and qualitative software were used to collect and analyze the data.

Results

Five themes were identified: perceiving symptoms, alleviating actions and control, normalizing symptoms, absence of help seeking behaviors, and decreased functional capacity. Normalizing symptoms included actions taken by participants to mitigate symptom fluctuations. Daily fluctuations were assimilated into normal life resulting in desensitization of symptom recognition and decreased functional capacity.

Conclusions

Findings support the need to educate on early symptom recognition, the benefits of safe physical activity, and building a system to support self-management patient-physician collaboration.  相似文献   

13.

Background

The mechanisms contributing to the success of cardiac rehabilitation (CR) are poorly understood and may include assessment, monitoring and review activities enabled by continuity of care and this is investigated in this study.

Objectives

To identify active assessment components of CR.

Methods

A qualitative study using focus groups and individual interviews. CR staff (n = 39) were recruited via professional association email and network contacts and organised into major themes.

Results

CR staff assessment strategies and timely actions undertaken provided a sophisticated post-discharge safety net for patients. Continuity of care enabled detection of adverse health indicators, of which medication issues were prominent. Interventions were timely and personalised and therefore likely to impact outcomes, but seldom documented or reported and thus invisible to audit.

Conclusion

CR staff assessment and intervention activities provide an unrecognised safety net of activities enabled by continuity of care, potentially contributing to the effectiveness of CR.  相似文献   

14.

Background

Music listening has been shown to reduce anxiety, stress, and patient tolerance of procedures. Music may also have beneficial effects on inflammatory biomarkers in intensive care and post-operative patients, but the quality of evidence is not clear.

Objectives

We conducted a systematic review to evaluate the effects of music on inflammatory biomarkers in intensive care, and post-operative patients.

Methods

A comprehensive search of the literature was performed. After screening 1570 references, full text review of 26 studies was performed. Fourteen studies were selected for inclusion.

Results

Seven studies showed a significant decrease in cortisol levels, but the level of evidence was low. Three studies had low risk of methodological bias, while 11 studies had high risk of bias.

Conclusions

Music intervention may decrease cortisol levels, but other biomarkers remain unchanged. Given the low level of evidence, further research on music effects on inflammatory biomarkers is needed.  相似文献   

15.

Background

Patients with thoracic empyema have an increased risk of mortality, but their absolute rate of mortality depends on age and comorbidities.

Objective

This study seeks to assess the predictive value of the Charlson Comorbidity Index score (CCIS), CHADS2 and CHA2DS2-VASc scores for mortality risk in patients with empyema thoracis.

Methods

From Taiwan's National Health Insurance Research Database we identified a total of 484 participants diagnosed with thoracic empyema. The CCIS, CHADS2 and CHA2DS2-VASc scores were used to stratify mortality risk.

Results

The incidence rate of mortality in the present study was 20.39 per 1000 person-months. A strong correlation was found between thoracic empyema and CCIS score.

Conclusions

Our results show that patients with thoracic empyema have a significantly high incidence rate of mortality and that CCIS can be used as an indicator of risk for mortality.  相似文献   

16.

Background

Despite the increasing use of implantable cardioverter defibrillators (ICDs) as a preventive approach for high-risk patients with arrhythmias, little is known about the perceptions of ICD recipients regarding these devices and their impact on quality of life.

Objectives

To explore perceptions towards quality of life, coping strategies, and learning needs of patients living with ICDs in Singapore.

Methods

16 participants (age ranges 52 to 84 years old) were purposively recruited and interviewed individually for this exploratory qualitative study. Data collected was analyzed using thematic analysis.

Results

Seven themes emerged: experiencing ICD shocks, ambivalent “love-hate” relationship with ICD, receiving support from healthcare professionals and social networks, attaining acceptance and returning to normalcy, physical coping, emotional coping, and readiness and need for enhanced patient education.

Conclusions

With an insight to the perceptions of ICD recipients in Singapore, future practice can focus on addressing their concerns and improve post-implantation quality of life.  相似文献   

17.

Background

Idiopathic capillary leak syndrome (Clarkson's Disease) is a rare angiopathy with a heterogenous phenotype that may present as distributive shock refractory to resuscitative management.

Objective

We report a case of idiopathic systemic capillary leak syndrome presenting as septic shock.

Methods

Structured case report and review of the literature.

Results

A 27-year old man admitted to our institution with coryzal symptoms rapidly deteriorated with presumed sepsis, leading to intensive care unit admission. Following further deterioration, Idiopathic systemic capillary leak syndrome was considered and intravenous immunoglobulin administered, resulting in rapid improvement in the patient's clinical status.

Conclusions

Idiopathic systemic capillary leak syndrome is a rare and potentially life-threatening angiopathy that may present as, and should be considered in, refractory distributive shock. Administration of intravenous immunglobulin resulted in rapid recovery in this patient, and has been associated with positive outcomes in previous cases.  相似文献   

18.

Background

Existing theory and evidence suggest that self-care confidence may mediate the relationship between Type D personality and self-care adherence.

Objectives

To assess the mediating role of self-care confidence between Type D personality and self-care adherence in Chinese HF patients.

Methods

This is a secondary analysis of a cross-sectional study. Self-care confidence and self-care adherence (maintenance) were measured by the subscales of the Self-Care of Heart Failure Index (v6). The Type D Scale-14 was administered to assess negative affect (NA), social inhibition (SI), and Type D personality. Mediation analysis based on Baron and Kenny was performed.

Results

A total of 127 HF patients were included. Self-care confidence partially mediated the relationship between Type D personality and self-care adherence but completely mediated the relationship between NA/SI and self-care adherence.

Conclusions

Clinicians may effectively improve self-care adherence by enhancing self-care confidence in HF patients with Type D personality.  相似文献   

19.

Objectives

To test the effects of group-based Tai chi on health-status outcomes among older adults with hypertension.

Background

A high-quality study exploring the effects of Tai chi on physical and psychosocial health for older adults with hypertension is needed in China. The long-term effects of group-based Tai chi in Chinese older adults with hypertension remain unclear.

Methods

A randomized controlled trial was conducted. The group-based Tai chi training and practice were implemented in older adults over six-month.

Results

The Tai chi (TC) group showed significantly lower blood pressure and body mass index than the usual care (UC) group. The TC group participants showed greater improvements in social support, quality of life, and reduction in depressive symptoms over a six-month intervention than UC group. TC group showed significant group-by-time interactions in these variables.

Conclusion

Group-based Tai chi is effective in the enhancement of health-status outcomes for older Chinese adults with hypertension.  相似文献   

20.

Introduction

Percutaneous mechanical circulatory support systems have increasingly been adopted as a bail out strategy in patients with cardiogenic shock. Since studies showed mostly mixed results, however, the use of support systems remains a case by case decision.

Case

Here, we report on a case of therapy-refractory cardiogenic shock due to acute myocardial infarction treated with percutaneous right and left ventricular assist devices (Impella RP and CP).

Conclusion

Due to myocardial stunning, even patients with fulminant cardiogenic shock have the potential for full recovery. In the present case, we demonstrate the feasibility of biventricular Impella support in therapy-refractory cardiogenic shock facilitating bridge to recovery.  相似文献   

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