- Survival and Quality of Life Following Elective Open-Heart Surgery | Article | NursingCenter
- Improving Outcomes and Quality of Life After CABG
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- Why did the researchers do this particular study?
- Assessment and pathophysiology of pain in cardiac surgery
Our study has several strengths. We have used a 3-arm interventional design that allowed us to compare three different conditions. There was also a 6-month follow-up to track the training benefits over time. But, there are also some limitations that should be noted.
First, the CCRT used in this study was focused on attention and working memory, so further studies would benefit from targeting other cognitive functions including executive functions Rezapour et al. Another limitation of this study is related to the high rate of drop-out at 6-month follow-up that should be considered and controlled in future studies. In conclusion, the results obtained in this study with regard to improvement of cognitive functions as well as QoL in patients after CABG surgery, may follow valuable clinical implications for those who provide health care services for this group of patients.
This study was carried out in accordance with the recommendations of Ethics Committee of the Iranian Ministry of Health reference number: IR. All patients gave written informed consent in accordance with the Declaration of Helsinki. SA and SE were responsible for data collection and for evaluations and treatments. MH was responsible for data analysis. TR and SA contributed to the interpretation of data. All authors have approved the final version of the manuscript. HE and TR designed the Maghzineh architecture and games.
The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. We acknowledge the Tehran Heart Center Hospital for use of their facilities.
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We are greatly thankful to the study participants for their interest and cooperation in the project. Aldena, S. Effect of intense lifestyle modification and cardiac rehabilitation on psychosocial cardiovascular disease risk factors and quality of life. Anderson, V. Long-term outcome from childhood traumatic brain injury: intellectual ability, personality, and quality of life. Neuropsychology 25, — Asghari, A. Psychometric properties of the depression anxiety stress scales DASS in a non-clinical Iranian sample.
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- Survival and Quality of Life Following Elective Open-Heart Surgery.
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Survival and Quality of Life Following Elective Open-Heart Surgery | Article | NursingCenter
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Improving Outcomes and Quality of Life After CABG
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The main finding of our study is coming up from the multivariate analysis, where the given variables age, gender, type of surgery, preoperative PCS and MCS were tested on their influence on potential non-improvement of HRQOL after cardiac surgery. The highest risk of non-improvement in postoperative quality of life was found in patients with higher preoperative PCS and MCS scores.
We have also found that non-survivors showed a significantly lower preoperative HRQOL than survivors. Rumsfeld et al. The results indicate that the preoperative health status was significantly different in the HRQOL of survivors and was the major determinant of change in quality of life following surgery.
Factors presented as being associated with failure to achieve a better HRQOL outcome in the postoperative period include the following: one or more preoperative comorbidities and postoperative low cardiac output [ 27 ], low preoperative ejection fraction [ 28 ], preoperative ICU stay or perioperative complications [ 29 ], a higher dyspnea classification, experiencing a new cardiac arrhythmia during or after the surgery, higher pulmonary pressure, previous cardiac surgery, previous myocardial infarction, and manual occupation [ 14 , 30 ].
Based on these results we can conclude, that patients with distinctly low preoperative HRQOL status are also in very poor clinical conditions and the risk of death is increased. The most frequent postoperative complications in the group of older patients were previously described as heart failure, dysrhythmia, postoperative bleeding, ventilation problems, neurophysical disorders, myocardial dysfunction, and renal failure [ 6 ]. Engoren et al. In another study, Dumbor et al. Frelich et al. In the present situation, when the economic view on medical care is projecting more and more into everyday practice, our efforts should be oriented toward these high-risk patients because most of the complications are related to preoperative status and can be reduced through careful preoperative conditioning, gentle operating techniques, and appropriate postoperative care.
In cardiac surgery, as in other fields, there continue to be developed new operating methods e. The HRQOL improves early after cardiac operations an remains relatively constant in the long term even after three years [ 33 ], what makes the period of one year after surgery sufficient for HRQOL observation. Same result was also described by the group of Gjeilo [ 34 ].
We observed relatively higher values of preoperative SF scores for HRQOL in younger patients, but the differences between preoperative and postoperative SF scores were greater in the older group. This could lead to the conclusion that older patients obtain relatively greater benefit from cardiac surgery than do younger patients in the period of one year after surgery, when most of the postoperative complications have been resolved. Some of the earlier studies using the SF questionnaire have presented only summaries of the SF scores.
For example, they report changes in physical health status derived from physical functioning, role physical, bodily pain, and general health and mental health status derived from vitality, social functioning, role emotional, and mental health [ 28 , 29 ]. We have used summaries of the SF only in the multivariate analysis, which, in our opinion, is a better and more convenient tool for use as a predictor of postoperative course. We should comment also on the limitations of this study. Nevertheless, we believe that this study can be the basis for additional research which could prove our conclusions and provide a stronger tool for identifying older people who are likely to experience HRQOL improvement after cardiac surgery.
During the study period none of the operative techniques were changed, and that could probably have reduced the potential bias of our longitudinal sample. In our opinion, the preoperative HRQOL assessment should be an important part of the preoperative examination, especially in the high-risk patients.
Our findings lead us to conclude that older patients with relatively higher cardiac operative risk have lower preoperative HRQOL, but they are more likely to exhibit significant improvement in HRQOL postoperatively. If we are able to offer these patients more gentle operative techniques and appropriate postoperative care, then we can achieve not only significant reduction in the number of postoperative complications and mortality but also improvement in their HRQOL. The authors are interested in issues of senior-age care in cardiac surgery.
In their everyday practice they are striving to improve preoperative conditioning, surgical techniques and postoperative care in order to minimize operative risk for older patients undergoing cardiac surgery.
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Why did the researchers do this particular study?
Scripta Medica. Age Ageing. J Thorac Cardiovasc Surg. Am J Med. J Thorac Cardiovas Sur. Eur J Heart Fail. Ware JE: SF health survey update. Qual Life Res. Statistica 10 software Czech version.swinzhengrecrasa.cf
Assessment and pathophysiology of pain in cardiac surgery
Ann Thorac Surg. Am J Cardiol. Arch Surg.