The Short- and Long-Term Outcome of Left Internal Mammary Artery Angioplasty

Failure of internal mammary artery (IMA) bypass grafts is uncommon. However, as their use continues to increase, this complication will be encountered more frequently by interventional cardiologists. The purpose of this article is to describe the short- and long-term outcome of patients undergoing IMA angioplasty through a retrospective review of patients undergoing internal mammary angioplasty at two centers from January 1988 to June 1995. Percutaneous recanalization was attempted on 82 lesions either within an IMA or in the ongoing native left anterior descending artery during 74 procedures in 67 patients. The mean time from bypass surgery was 23 months. The lesion success rate was 84%. Dissection of the IMA occurred in 18% of procedures and was the most common cause for procedural failure and unfavorable outcome. Long-term follow-up was available in 82% of patients at a mean follow-up of 45 months postprocedure. Clinical events occurred in 23 patients (34%) with 4 deaths (1 of which occurred during the initial hospitalization and after emergency bypass surgery), 2 repeat coronary bypass operations, and 17 patients with repeat coronary angioplasties. Despite the high repeat revascularization rate, 80% of patients were asymptomatic or had only infrequent angina at follow-up. We conclude that angioplasty of or through an IMA bypass graft can be performed with a satisfactory procedural success rate and long-term symptomatic benefit.     

Assessing health needs in people with severe learning disabilities: a qualitative approach

Summary

• ? The nursing assessment, and the contribution it makes to the identification of an individual's health needs, is often a complex and multidimensional process. This is always true when the individual concerned has a severe learning disability.
• ? The nurse should develop the assessment in partnership with individuals who may experience major communication difficulties, or have unappreciated levels of perceptual or cognitive dysfunction. They may also live with the ongoing possibility that their affective or behavioural responses may be misinterpreted as ‘challenging behaviour’.
• ? This case study focuses upon one particular young man with a severe learning disability living in a community home. Drawing upon the principles of qualitative research methods, especially those of ‘grounded theory’, this study aims to demonstrate how these can be used to develop a uniquely person-centred assessment.
• ? A systematic process of observation, analysis and reflection produces a detailed picture of the individual and his or her particular health states.
• ? The strength of this approach is threefold. Firstly, the person is considered as an active participant and remains the central focus. Secondly, in contrast to many other forms of assessment, the person is viewed as dynamic with ever changing needs. Thirdly, the process of nursing judgement is made explicit and integrated into the assessment process.