Cardiac rehabilitation referral and attendance: not one and the same.

Despite empirical evidence that cardiac rehabilitation programs can play a significant role in enhancing recovery following a primary cardiac event and in enacting secondary prevention measures, attendance rates remain remarkably low. Referral and attendance at cardiac rehabilitation programs are not one and the same. Recognizing this, issues related to the referral of eligible patients to cardiac rehabilitation and factors that affect patients' decisions regarding attendance must be identified and addressed. This article presents an overview of the potential benefits of cardiac rehabilitation programs, describes salient issues related to referral and attendance, and identifies directions for future research.     

Decreases in arterial oxygen saturation in paediatric outpatients during transfer to the postanaesthetic recovery room

Arterial oxygen saturation was measured by pulse oximetry in two groups of paediatric outpatients breathing room air during transport from the operating room to the postanaesthetic recovery room. In Group I (n = 60) readiness for transfer from OR to PARR was decided clinically. In Group II (n = 50) additional criteria of oxygen saturation (SaOe) greater than or equal to 98 per cent with end-tidal gas N2O less than or equal to 10 per cent and CO2 less than or equal to 45 mmHg were met. A higher incidence of desaturation (SaO2 less than or equal to 90 per cent) occurred in Group I (27 per cent) than in Group II (eight per cent) (P less than 0.05). More children under 2 yr desaturated in Group I (50 per cent) than Group II (17 per cent) (P greater than 0.05 less than 0.10). Twenty-two patients in each group had a recent history of upper respiratory tract infections. In these patients, desaturation was more marked in those in Group I (32 per cent) than in Group II (five per cent) (P less than 0.05). Within each group, the incidence of desaturation during transport was similar in patients with or without a recent URI.     

Epithelial cell proliferation in the rat urinary system induced by parenteral injection of lead salts.

In Wistar rats a single intravascular injection of lead nitrate causes substantial cellular proliferation in the proximal tubules of the kidneys and in the epithelium of the renal pelvis, ureters and urinary bladder. The tritiated thymidine labelling index (LI) reaches a peak 18 to 24 h after injection and the mitotic index (MI) increases to a comparable extent 6 to 10 h later. The proliferation is most prominent in the bladder and proximal tubules and is virtually complete at 48 h. After a single intraperitoneal injection the proliferative changes are confined to the ureteric and bladder epithelium. In all affected tissues the proliferation develops without preceding necrosis and appears to be a hyperplastic phenomenon. After intravascular administration the volume of urine and its total protein content are significantly increased and certain proteins were detected which were not present in the urine of saline controls.     

Lower extremity arterial occlusive disease.

The clinician must first understand the natural history of chronic lower extremity ischemia before making a decision regarding therapeutic options. Clearly, mild ischemia as evidenced by claudication does not place the patient at significant risk for limb loss. Initial conservative treatment emphasizing abstinence from tobacco products, control of underlying medical maladies, and an exercise program, along with patient reassurance, will adequately treat the majority of claudicators. When ischemia is present, patient education regarding foot care and avoidance of trauma are beneficial. Limb-threatening ischemia often requires revascularization. Adequate preoperative cardiologic evaluation and intraoperative monitoring have greatly reduced the morbidity and mortality of arterial reconstruction. Selection of the appropriate recipient vessel and bypass conduit enables limb salvage, whereas amputation would have been performed just a few years ago. Continued analysis of treatment outcomes will further define appropriate intervention in the future.     

Coronary artery bypass graft surgery in older women and men.

OBJECTIVE: To compare women and men younger than 70 years of age and 70 years or older undergoing coronary artery bypass surgery. DESIGN: Retrospective chart review, case-control series. SETTING: University medical center. PATIENTS: All women (n = 465) having first-time isolated coronary artery bypass surgery between 1983 and 1988, and 465 men matched for age and year of surgery. Predominantly white; 33% were 70 years or older. MEASURES: Medical record data: demographics, preoperative comorbidities, perioperative and postoperative complications, mortality, length of stay. RESULTS: Preoperatively, women 70 years of age or older had a higher incidence of congestive heart failure, renal disease and hypertension, and a lower incidence of smoking history compared with women less than 70 years old. Men 70 years or older had a higher incidence of congestive heart failure and renal disease, and a lower incidence of smoking history compared with men less than 70 years old. There was no difference in mortality between older and younger women, whereas the mortality rate for older men was higher than that for younger men. There were fewer differences between women younger than 70 and those 70 years or older in incidence of postoperative complications than between men of those same age groups. Among patients 70 years or older, incidence of postoperative congestive heart failure was greater in women than in men. There were no other differences between women and men younger than 70 and those 70 years or older in incidence of postoperative complications. Controlling for the influence of postoperative complications, age was related to length of stay for women and men. CONCLUSIONS: Older women were at no greater risk of mortality or the occurrence of postoperative complications compared with younger women or older men. A functional component influencing recovery and length of hospital stay needs to be considered to provide optimal nursing care after surgery.     

Effects of methylphenidate and behavior modification on the social and academic behavior of children with disruptive behavior disorders: the moderating role of callous/unemotional traits.

This study examined whether response to behavior modification with and without methylphenidate differed for children with attention-deficit/hyperactivity disorder (ADHD) and conduct problems (CP) depending on the presence of callous/unemotional (CU) traits. Participants were 37 children ages 7 to 12, including 19 with ADHD/CP-only and 18 with ADHD/CP-CU, referred to a university-based summer treatment program. Results showed that ADHD/CP-CU children had worse behavior in the behavior-therapy-only (BT-only) condition, especially on measures of CP, noncompliance, and rule violations, but these differences largely disappeared when medication was added to BT. Children with ADHD/CP-CU were also less likely to be normalized by treatment than were children with ADHD/CP-only. These findings, though tentative, suggest that children with ADHD/CP-CU may not show a sufficient positive response to BT alone and that the combination of medication and BT may be especially important for them.