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Pubblicazioni recenti - cardiac rehabilitation
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Management of the mild traumatic brain injured patient using a multidisciplinary observation unit protocol.
Am J Emerg Med2020 Jul;():. doi: S0735-6757(20)30592-1.
Rhame Katherine, Le Diana, Ventura Amanda, Horner Amy, Andaluz Norberto, Miller Christopher, Stolz Uwe, Ngwenya Laura B, Adeoye Opeolu, Kreitzer Natalie,
Abstract
OBJECTIVES:
We developed an ED based multidisciplinary observation unit (OU) protocol for patients with mild traumatic brain injury (mTBI). We describe the cohort of patients who were placed in the ED OU and we evaluated if changes to our inclusion and exclusion criteria should be made.
METHODS:
We conducted a retrospective cohort study to evaluate subjects who were admitted to the mTBI observation protocol. We included adults within 24 h of sustaining an mTBI with a Glasgow Coma Scale (GCS) of 14 or 15 who had pre-specified head CT findings, and did not meet exclusion criteria. Predictors of need for hospital admission after completing the OU protocol were determined using multivariable logistic regression analysis.
RESULTS:
The mean age was 49 (SD 23), 58 (33%) were female, and 136 (78%) were Caucasian. No subjects discharged home required a surgical intervention or ICU admission, and there were no deaths in discharged or admitted subjects. 28 subjects (16%) were admitted to the hospital following their OU stay. Subjects admitted were older (mean age: 56 vs. 48, p = 0.1) and had a higher proportion of traumatic bleeds on head CT (85% vs. 76%, p = 0.3). In multivariable logistic regression, GCS of 15 (aOR 4.24), African-American race (aOR 5.84), and no comorbid cardiac disease predicted discharge home after the observation protocol (aOR 0.28).
CONCLUSIONS:
A period of observation for a pre-defined cohort of patients with mTBI provided a triage plan that could allow appropriate patient management without requiring admission in the majority of subjects.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Health-related quality of life correlates with time in therapeutic range in children on anticoagulants with International Normalised Ratio self-monitoring.
Arch Cardiovasc Dis2020 Oct;():. doi: S1875-2136(20)30199-6.
Abassi Hamouda, Bajolle Fanny, Werner Oscar, Auer Annie, Marquina Amandine, Mura Thibault, Lavastre Kathleen, Guillaumont Sophie, Manna Federico, Auquier Pascal, Bonnet Damien, Amedro Pascal,
Abstract
BACKGROUND:
Managing oral anticoagulant therapy with vitamin K antagonists remains challenging in paediatric medicine.
AIMS:
This study aimed to assess the correlation between time in therapeutic range and quality of life in children participating in a non-selective International Normalised Ratio self-monitoring and vitamin K antagonist education programme.
METHODS:
Children aged from 2 to 18 years and receiving vitamin K antagonist therapy were eligible for this prospective multicentre study. Clinical and demographic data were collected. Health-related quality of life was assessed using the PedsQL? 4.0 questionnaire. Correlations between quality of life scores and time in therapeutic range were measured.
RESULTS:
A total of 121 children were included in the study (mean age 9.6±4.9 years). Cardiac conditions were the predominant indication for vitamin K antagonists. The mean time in therapeutic range was 0.78±0.15 overall, and 0.76±0.24 over the 3-month period before quality of life assessment. The mean total quality of life score was 76.2±18 in self reports, 71.4±22 in mother reports and 73.5±19 in father reports. The time in therapeutic range correlated with the total quality of life scores in self reports (r=0.22; P=0.04), mother reports (r=0.23; P=0.02) and father reports (r=0.28; P=0.02). The time in therapeutic range predominantly correlated with school functioning in self reports (r=0.38; P=0.002) and mother reports (r=0.40; P<0.001), and with physical functioning in father reports (r=0.28; P=0.03).
CONCLUSIONS:
Time in therapeutic range correlated with quality of life in children participating in a non-selective International Normalised Ratio self-monitoring and vitamin K antagonist education programme. Regular assessment of quality of life in patient education programmes contributes towards understanding the concerns and needs of patients.
Copyright © 2020 Elsevier Masson SAS. All rights reserved.
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Are our nurses healthy? Cardiorespiratory fitness in a very exhausting profession.
Cent Eur J Public Health2020 Oct;28(Supplement):S53-S56. doi: 10.21101/cejph.a6210.
Sovová Markéta, Sovová Eli?ka, Nakládalová Marie, Pokorná Tereza, ?tégnerová Lenka, Masný Old?ich, Moravcová Katarína, ?t?pánek Ladislav,
Abstract
OBJECTIVES:
Low cardiorespiratory fitness (CRF) is related to higher risk of cardiovascular diseases, increase in all-cause mortality and higher risk of different tumors. The reverse is also true; improvement in CRF is related to decrease in mortality. Cardiopulmonary exercise testing (CPET) is a standard and also the most precise test for determination of CRF - the best possibility is the maximal test measuring different parameters including maximal oxygen consumption. Healthcare professionals throughout the developed world have markedly high rates of sickness absence, burnout, and distress compared to other sectors and this leads to higher risk factors. The study aimed to assess CRF in a group of nurses in a big hospital and compare it with population norms and available published results.
METHODS:
Nurses over 50 years of age working in one faculty hospital were gradually included in the study from the beginning of 2018. These nurses work in physically demanding positions. A CPET was carried out following the Bruce protocol.
RESULTS:
90 nurses (84 females and 6 males), mean age 55.7 years, were evaluated by CPET. The resting blood pressure was within the norm in 58 persons (64.44%), maximal oxygen consumption in 61 persons (67.8%), W/kg in 25 persons (46.2%). We detected a hypertension reaction in 28 persons (31.1%), some types of arrhythmia in 17 persons (18.9%) and signs of ischaemia in 8 persons (8.9%). The result of CPET led to further examination in 42 persons (46.6%). Detailed examination resulted in change of medication in 21 nurses (23.3%). New diseases were diagnosed in 15 nurses (hypertension, atrial fibrillation, mitral valve prolapse indicated for cardiac surgery, coronary artery stenosis, and lipid disorders).
CONCLUSIONS:
It was concluded that the usage of CPET during the regular medical check-ups significantly increases detection of hidden diseases and thus improves the care for nurses.
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Diffuse and patchy intra-myocardial fat deposition in left ventricle: unclassified cardiomyopathy in an obese woman without pathological condition.
Indian J Thorac Cardiovasc Surg2019 Apr;35(2):249-252. doi: 10.1007/s12055-018-00782-y.
Esfahani Morteza Abdar, Heshmat-Ghahdarijani Kiyan, Baghayi Abdolmajid, Vakhshoori Mehrbod, Abdshahzadeh Hormoz, Abrishamchi Reyhaneh,
Abstract
Fat deposition in the left ventricle in patients without proven myocardial diseases has not been sufficiently investigated. In this paper, a case of diffuse and patchy intramyocardial fat deposition in the left ventricular myocardium in a patient with no cardiac disease history has been detected by cardiac magnetic resonance imaging (CMRI). Such a finding would not be considered a usual cardiomyopathy and further studies are needed to investigate its prevalence, pathophysiological mechanisms, and prognosis.
© Indian Association of Cardiovascular-Thoracic Surgeons 2019.
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Hybrid myocardial revascularization.
Indian J Thorac Cardiovasc Surg2018 Dec;34(Suppl 3):310-320. doi: 10.1007/s12055-018-0646-y.
Mishra Yugal Kishore, Yadav Jatin,
Abstract
Background:
In patients with advanced coronary artery disease (CAD), coronary artery bypass grafting (CABG) is associated with improved long-term outcomes while percutaneous coronary intervention (PCI) is associated with lower periprocedural complications. A new approach has emerged in the last decade that attempts to reap the benefits of bypass surgery and stenting while minimizing the shortcomings of each approach, hybrid myocardial revascularization (HMR).Three strategies for timing of the hybrid revascularization exists, each with their own inherent advantages and shortcomings: (1) CABG followed by PCI, (2) PCI followed by CABG, or (3) simultaneous CABG + PCI in a hybrid suite.
Studies:
The results of the first randomized control trial comparing HMR (CABG first) and standard CABG, POL-MIDES (Prospective Randomized PilOt Study EvaLuating the Safety and Efficacy of Hybrid Revascularization in MultIvessel Coronary Artery DisEaSe), show HMR was feasible for 93.9% of patients whereas conversion to standard CABG was required for 6.1%. At 1 year, both groups had similar all-cause mortality (CABG 2.9% vs. HMR 2%) and major adverse clinical event (MACE)-free survival rates (CABG 92.2% vs. HMR 89.8%). Results of observational and comparative studies show that minimally invasive HMR procedures in patients with multivessel CAD carry minimal perioperative mortality risk and low morbidity and do not increase the risk of postoperative bleeding. The advantage they offer in comparison to classical surgical revascularization is indeed faster rehabilitation and patient's return to normal life.
Conclusion:
Hybrid myocardial revascularization has been developed as a promising technique for the treatment of high-risk patients with CAD. Hybrid revascularization using minimally invasive surgical techniques combined with PCI offers to a part of patients an advantage of optimal revascularization of the most important artery of the heart, together with adequate myocardial revascularization in a relatively delicate way. Indeed, to patients with high operative risk of standard surgery, it offers an alternative which should be considered carefully.
© Indian Association of Cardiovascular-Thoracic Surgeons 2018.
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Medical Treatment in Coronary Patients: Is there Still a Gender Gap? Results from European Society of Cardiology EUROASPIRE V Registry.
Cardiovasc Drugs Ther2020 Oct;():. doi: 10.1007/s10557-020-07095-6.
Vynckier Pieter, Ferrannini Giulia, Rydén Lars, Tokgözo?lu Lale, Bruthans Jan, Kotseva Kornelia, Wood David, De Backer Tine, Gevaert Sofie, De Bacquer Dirk, De Smedt Delphine, ,
Abstract
PURPOSE:
This study is aimed at investigating gender differences in the medical management of patients with coronary heart disease (CHD).
METHODS:
Analyses were based on the ESC EORP EUROASPIRE V (European Survey Of Cardiovascular Disease Prevention And Diabetes) survey. Consecutive patients between 18 and 80 years, hospitalized for a coronary event, were included in the study. Information on cardiovascular medication intake at hospital discharge and at follow-up (??6 months to
RESULTS:
Data was available for 8261 patients (25.8% women). Overall, no gender differences were observed in the prescription and use of cardioprotective medication like aspirin, beta-blockers, and ACE-I/ARBs (P?>?0.01) at discharge and follow-up respectively. However, a statistically significant difference was found in the use of statins at follow-up, in disfavor of women (82.8% vs. 77.7%; P??0.01). Furthermore, women were less likely than men to have received a CABG (20.4% vs. 13.2%; P?
CONCLUSION:
The EUROASPIRE V results show only limited gender differences in the medical management of CHD patients. Current findings suggest growing awareness about risk in female CHD patients.
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Socioeconomic characteristics of patients with coronary heart disease in relation to their cardiovascular risk profile.
Heart2020 Oct;():. doi: heartjnl-2020-317549.
De Bacquer Dirk, van de Luitgaarden Inge A T, De Smedt Delphine, Vynckier Pieter, Bruthans Jan, Fras Zlatko, Jankowski Piotr, Dolzhenko Marina, Kotseva Kornelia, Wood David, De Backer Guy,
Abstract
OBJECTIVE:
People's socioeconomic status (SES) has a major impact on the risk of atherosclerotic cardiovascular disease (ASCVD) in primary prevention. In patients with existing ASCVD these associations are less documented. Here, we evaluate to what extent SES is still associated with patients' risk profile in secondary prevention.
METHODS:
Based on results from a large sample of patients with coronary heart disease from the European Action on Secondary and Primary Prevention through Intervention to Reduce Events study, the relationship between SES and cardiovascular risk was examined. A SES summary score was empirically constructed from the patients' educational level, self-perceived income, living situation and perception of loneliness.
RESULTS:
Analyses are based on observations in 8261 patients with coronary heart disease from 27 countries. Multivariate logistic regression analyses demonstrate that a low SES is associated (OR, 95%?CI) with lifestyles such as smoking in men (1.63, 1.37 to 1.95), physical activity in men (1.51, 1.28 to 1.78) and women (1.77, 1.32 to 2.37) and obesity in men 1.28 (1.11 to 1.49) and women 1.65 (1.30 to 2.10). Patients with a low SES have more raised blood pressure in men (1.24, 1.07 to 1.43) and women (1.31, 1.03 to 1.67), used less statins and were less adherent to them. Cardiac rehabilitation programmes were less advised and attended by patients with a low SES. Access to statins in middle-income countries was suboptimal leaving about 80% of patients not reaching the low-density lipoprotein cholesterol target of <1.8?mmol/L. Patients' socioeconomic level was also strongly associated with markers of well-being.
CONCLUSION:
These results illustrate the complexity of the associations between SES, well-being and secondary prevention in patients with ASCVD. They emphasise the need for integrating innovative policies in programmes of cardiac rehabilitation and secondary prevention.
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
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Will Research on COVID-19 Stimulate the Identification of Immunological Mechanisms Underlying Some Protective Effects?
Ann Am Thorac Soc2020 Oct;():. doi: 10.1513/AnnalsATS.202009-1139LE.
Incorvaia Cristoforo, Ridolo Erminia, Febo Oreste C,
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Perceived Need for Psychosocial Support After Aortic Dissection: Cross-Sectional Survey.
J Particip Med2020 Jul;12(3):e15447. doi: 10.2196/15447.
Meinlschmidt Gunther, Berdajs Denis, Moser-Starck Roger, Frick Alexander, Gross Sebastian, Schurr Ulrich, Eckstein Friedrich S, Hunziker Sabina, Schaefert Rainer,
Abstract
BACKGROUND:
The gold standard management of aortic dissection, a life-threatening condition, includes multidisciplinary approaches. Although mental distress following aortic dissection is common, evidence-based psychosocial interventions for aortic dissection survivors are lacking.
OBJECTIVE:
The aim of this study is to identify the perceived psychosocial needs of aortic dissection survivors by surveying patients, their relatives, and health professionals to inform the development of such interventions.
METHODS:
This study used a cross-sectional survey and collected responses from 41 participants (27 patients with aortic dissection, 8 relatives of patients with aortic dissection, and 6 health professionals) on key topics, types of interventions, best timing, anticipated success, and the intended effects and side effects of psychosocial interventions after aortic dissection.
RESULTS:
The principal intervention topics were "changes in everyday life" (28/41, 68%, 95% CI 54.5%-82.9%), "anxiety" (25/41, 61%, 95% CI 46.2%-76.2%), "uncertainty" (24/41, 59%, 95% CI 42.9%-73.2%), "tension/distress" (24/41, 59%, 95% CI 43.9%-73.8%), and "trust in the body" (21/41, 51%, 95% CI 35.9%-67.5%). The most commonly indicated intervention types were "family/relative therapy" (21/41, 51%, 95% CI 35%-65.9%) and "anxiety treatment" (21/41, 51%, 95% CI 35%-67.5%). The most recommended intervention timing was "during inpatient rehabilitation" (26/41, 63%, 95% CI 47.6%-77.5%) followed by "shortly after inpatient rehabilitation" (20/41, 49%, 95% CI 32.4%-65%). More than 95% (39/41) of respondents anticipated a benefit from psychosocial interventions following aortic dissection dissection, expecting a probable improvement in 68.6% (95% CI 61.4%-76.2%) of aortic dissection survivors, a worse outcome for 5% (95% CI 2.9%-7.9%), and that 6% (95% CI 1.8%-10.4%) would have negative side effects due to such interventions.
CONCLUSIONS:
Our findings highlight a substantial need for psychosocial interventions in aortic dissection survivors and indicate that such interventions would be a success. They provide a basis for the development and evaluation of interventions as part of state-of-the-art aortic dissection management.
©Gunther Meinlschmidt, Denis Berdajs, Roger Moser-Starck, Alexander Frick, Sebastian Gross, Ulrich Schurr, Friedrich S Eckstein, Sabina Hunziker, Rainer Schaefert. Originally published in Journal of Participatory Medicine (http://jopm.jmir.org), 06.07.2020.
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Extracorporeal Membrane Oxygenation Retrieval in Coronavirus Disease 2019: A Case-Series of 19 Patients Supported at a High-Volume Extracorporeal Membrane Oxygenation Center.
Crit Care Explor2020 Oct;2(10):e0228. doi: 10.1097/CCE.0000000000000228.
Riera Jordi, Argudo Eduard, Martínez-Martínez María, García Sandra, García-de-Acilu Marina, Santafé Manel, Díaz Cándido, Contreras Sofía, Cortina Alexandra, Bonilla Camilo, Pacheco Andrés, Resta Paula, Palmer Neiser, Castro Miguel Ángel, Ferrer Ricard,
Abstract
Objective:
To evaluate the performance of the extracorporeal membrane oxygenation retrieval team at a high-volume extracorporeal membrane oxygenation center during the coronavirus disease 2019 pandemic.
Design:
Observational study including all adult patients with confirmed infection due to severe acute respiratory syndrome coronavirus-2 cannulated at other centers and transported on extracorporeal membrane oxygenation to the ICU of the Vall d'Hebron University Hospital between 15 March and 10 June 2020.
Setting:
The ICU (capacity expanded to 200 during the pandemic) of the Vall d'Hebron University Hospital (a 1,100-bed public university hospital in Barcelona), the referral center for extracorporeal respiratory support in Catalonia (7.5 million inhabitants).
Patients:
Extracorporeal membrane oxygenation was considered if the Pao/Fio ratio less than 80?mm Hg (refractory to prone position) and/or Paco greater than 80?mm Hg and pH less than 7.25 for more than 6 hours, and no contraindications for extracorporeal support were present.
Interventions:
Venovenous extracorporeal membrane oxygenation was initiated in the primary center. Then, patients were transferred to the ICU of the Vall d'Hebron University Hospital where they received support until respiratory improvement. After decannulation, patients were discharged for rehabilitation at the primary center.
Measurements and Main Results:
Nineteen patients with severe acute respiratory syndrome coronavirus-2 infection and with a mean Pao/Fio ratio of 71?mm Hg (57-118?mm Hg) despite prone positioning and a mean Paco of 70?mm Hg (47-110?mm Hg) were transferred to our center from their primary hospital after cannulation and received venovenous extracorporeal membrane oxygenation support. Prior to cannulation, six patients (31.5%) presented vascular thrombosis, and nine (47.4%) were already receiving anticoagulant therapy. Eighteen transfers were carried out with no significant complications. While on extracorporeal membrane oxygenation, thrombotic events were recorded in nine patients (47.4%) and hemorrhagic events in 13 (68.4%). Thirteen patients (68.4%) were successfully weaned, and 12 (63.1%) were discharged home.
Conclusions:
Extracorporeal membrane oxygenation retrieval can rescue young, previously healthy patients with severe coronavirus disease 2019 in whom all the conventional respiratory measures have failed. Thrombotic and hemorrhagic complications are frequent in this cohort.
Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.
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Knowledge and Attitude of the Medical Staff Concerning Cardiac Rehabilitation in Zhejiang Province, China: A Cross-Sectional Study.
Patient Prefer Adherence2020 ;14():1771-1777. doi: 10.2147/PPA.S270503.
Zhu Haixiang, Ye Zhihong, Ning Li, Han Xiaoxue, Wu Yuan,
Abstract
Purpose:
This study aimed to investigate the status of cardiac rehabilitation knowledge and attitude of the medical staff.
Patients and Methods:
A questionnaire survey of doctors and nurses was performed in the departments of cardiology of 7 teaching hospitals with attitudes, knowledge toward CR in Zhejiang Province, China, from April to September 2018, to assess Chinese medical staff for the degree of mastery and attitude toward cardiac rehabilitation.
Results:
A total of 160 questionnaires were distributed and 152 valid were collected. The responding individuals included 106 nurses (69.74%) and 46 doctors (30.26%). The scores of cardiac rehabilitation knowledge were 56.68±5.06, and those of cardiac rehabilitation attitude were 15.19±3.86. Subgroup analysis showed the lower the job title (P<0.001), the lower the educational level (P = 0.011), and the shorter the years of specialty experience (P=0.005), the more negative the attitude toward cardiac rehabilitation.
Conclusion:
The medical staff has a good mastery of cardiac rehabilitation knowledge. But we also find that staffs with lower education level and job title, shorter specialty work experience were associated with a more negative attitude toward implement rehabilitation.
© 2020 Zhu et al.
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A gap in post-stroke blood pressure target attainment at entry to cardiac rehabilitation.
Can J Neurol Sci2020 Oct;():1-32. doi: 10.1017/cjn.2020.231.
Sawicki Carolyn, Oh Paul, Marzolini Susan,
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Feasibility and functional correlates of left atrial volume changes during stress echocardiography in chronic coronary syndromes.
Int J Cardiovasc Imaging2020 Oct;():. doi: 10.1007/s10554-020-02071-5.
Morrone Doralisa, Arbucci Rosina, Wierzbowska-Drabik Karina, Ciampi Quirino, Peteiro Jesus, Agoston Gergely, Varga Albert, Camarozano Ana Cristina, Boshchenko Alla, Ryabova Tamara, Dekleva Milica, Simova Iana, Lowenstein Haber Diego M, Tesic Milorad, Boskovic Nikola, Djordjevic-Dikic Ana, Beleslin Branko, D'Alfonso Maria Grazia, Mori Fabio, Rodrěguez-Zanella Hugo, Kasprzak Jaroslaw D, Cortigiani Lauro, Lattanzi Fabio, Scali Maria Chiara, Torres Marco A R, Daros Clarissa Borguezan, de Castro E Silva Pretto José Luis, Gaibazzi Nicola, Zagatina Angela, Zhuravskaya Nadezhda, Amor Miguel, Mieles Paul E Vargas, Merlo Pablo Martin, Monte Ines, D'Andrea Antonello, Re Federica, Di Salvo Giovanni, Merli Elisa, Lorenzoni Valentina, De Nes Michele, Paterni Marco, Limongelli Giuseppe, Prota Costantina, Citro Rodolfo, Colonna Paolo, Villari Bruno, Antonini-Canterin Francesco, Carpeggiani Clara, Lowenstein Jorge, Picano Eugenio, ,
Abstract
An enlarged left atrial volume index (LAVI) at rest mirrors increased LA pressure and/or impairment of LA function. A cardiovascular stress may acutely modify left atrial volume (LAV) within minutes. Aim of this study was to assess the feasibility and functional correlates of LAV-stress echocardiography (SE) Out of 514 subjects referred to 10 quality-controlled labs, LAV-SE was completed in 490 (359 male, age 67?±?12 years) with suspected or known chronic coronary syndromes (n?=?462) or asymptomatic controls (n?=?28). The utilized stress was exercise in 177, vasodilator in 167, dobutamine in 146. LAV was measured with the biplane disk summation method. SE was performed with the ABCDE protocol. The intra-observer and inter-observer LAV variability were 5% and 8%, respectively. ?-LAVI changes (stress-rest) were negatively correlated with resting LAVI (r?=?- 0.271, p?
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Cognitive Improvement After Cochlear Implantation in Older Adults With Severe or Profound Hearing Impairment: A Prospective, Longitudinal, Controlled, Multicenter Study.
Ear Hear2020 Oct;():. doi: 10.1097/AUD.0000000000000962.
Mertens Griet, Andries Ellen, Claes Annes J, Topsakal Vedat, Van de Heyning Paul, Van Rompaey Vincent, Calvino Miryam, Sanchez Cuadrado Isabel, Muńoz Elena, Gavilán Javier, Bie?kowska Katarzyna, ?wierniak Weronika, Skar?y?ski Piotr Henryk, Skar?y?ski Henryk, Tapper Lynne, Killan Catherine, Ridgwell Jillian, McGowan Janet, Raine Christopher, Tavora-Vieira Dayse, Marino Roberta, Acharya Aanand, Lassaletta Luis,
Abstract
OBJECTIVE:
To compare the cognitive evolution of older adults with severe or profound hearing impairment after cochlear implantation with that of a matched group of older adults with severe hearing impairment who do not receive a cochlear implant (CI).
DESIGN:
In this prospective, longitudinal, controlled, and multicenter study, 24 older CI users were included in the intervention group and 24 adults without a CI in the control group. The control group matched the intervention group in terms of gender, age, formal education, cognitive functioning, and residual hearing. Assessments were made at baseline and 14 months later. Primary outcome measurements included the change in the total score on the Repeatable Battery for the Assessment of Neuropsychological Status for Hearing impaired individuals score and on its subdomain score to assess cognitive evolution in both groups. Secondary outcome measurements included self-reported changes in sound quality (Hearing Implant Sound Quality Index), self-perceived hearing disability (Speech, Spatial, and Qualities of Hearing Scale), states of anxiety and depression (Hospital Anxiety and Depression Scale), and level of negative affectivity and social inhibition (Type D questionnaire).
RESULTS:
Improvements of the overall cognitive functioning (p = 0.05) and the subdomain "Attention" (p = 0.02) were observed after cochlear implantation in the intervention group; their scores were compared to the corresponding scores in the control group. Significant positive effects of cochlear implantation on sound quality and self-perceived hearing outcomes were found in the intervention group. Notably, 20% fewer traits of Type D personalities were measured in the intervention group after cochlear implantation. In the control group, traits of Type D personalities increased by 13%.
CONCLUSION:
Intervention with a CI improved cognitive functioning (domain Attention in particular) in older adults with severe hearing impairment compared to that of the matched controls with hearing impairment without a CI. However, older CI users did not, in terms of cognition, bridge the performance gap with adults with normal hearing after 1 year of CI use. The fact that experienced, older CI users still present subnormal cognitive functioning may highlight the need for additional cognitive rehabilitation in the long term after implantation.
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Precision implementation of early ambulation in elderly patients undergoing off-pump coronary artery bypass graft surgery: a randomized-controlled clinical trial.
BMC Geriatr2020 Oct;20(1):404. doi: 10.1186/s12877-020-01823-1.
Cui Zhaomei, Li Na, Gao Chaonan, Fan Yiou, Zhuang Xin, Liu Jing, Zhang Jie, Tan Qi,
Abstract
BACKGROUND:
Although early ambulation (EA) is associated with improved outcomes in post-operative patients, implementation of EA in elderly patients is still a challenge. In this study, we aimed to design and assess a precision early ambulation program for cardiac rehabilitation.
METHODS:
We conducted a single-center, randomized and controlled clinical trial in elderly patients aged over 60?years after off-pump coronary artery bypass graft (OPCABG) surgery. Patients were randomly assigned to a precision early ambulation (PEA) group or a routine ambulation (Control) group. Age-predicted maximal heart rate (APMHR) and maximal oxygen uptake (VO were used as a reference to formulate and monitor the PEA regimen. The primary end-point was the postoperative length of stay in hospital (PLOS). The secondary end-points included 90-day mortality, incidence of early discharge, laboratory tests, length of ICU stay, the incidence of multiple organ complications and post-traumatic stress disorder (PTSD). Ambulation outcomes were also recorded.
RESULTS:
In total, 178 patients were enrolled (n?=?89 per group). In the intent-to-treat analysis, PLOS in the PEA group was shorter than that in the Control group (9.04?±?3.08 versus 10.09?±?3.32?days, respectively. Mean difference 1.045?days; 95% confidence interval [CI] 0.098-1.992; P?=?0.031 in the unadjusted model; mean difference 0.957?days; CI 0.007-1.907; P?=?0.048 in adjusted model). The incidence of early discharge differed significantly between the PEA and control groups (41[46.1%] versus 24[27.0%] patients, respectively. Odds ratio [OR] 0.432; CI 0.231-0.809; P?=?0.009 in unadjusted model; OR 0.466; CI 0.244-0.889, P?=?0.02 in adjusted model). The time of first bowel movement, partial pressure O and post-traumatic stress disorder score in the PEA group were better than those in the Control group. Participants walked much longer distances on day 3 in the PEA group than those in the Control group (76.12?±?29.02 versus 56.80?±?24.40?m, respectively, P < 0.001).
CONCLUSION:
APMHR and VO are valuable for implementation of PEA according to an established security threshold. PEA after OPCAPG surgery is safe and reliable for elderly patients, not only reducing the hospital stay, but also improving their physiological and psychological symptoms.
TRIAL REGISTRATION:
This study is a component of a protocol retrospectively registered: Application of ERAS in cardiovascular surgery.
TRIAL REGISTRATION NUMBER:
ChiCTR1800018167 . Date of registration: 3rd September, 2018. URL of trial registry record: http://www.chictr.org.cn/index.aspx.
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Sedentary behaviour and health in adults: an overview of systematic reviews.
Appl Physiol Nutr Metab2020 Oct;45(10 (Suppl. 2)):S197-S217. doi: 10.1139/apnm-2020-0272.
Saunders Travis J, McIsaac Travis, Douillette Kevin, Gaulton Nick, Hunter Stephen, Rhodes Ryan E, Prince Stephanie A, Carson Valerie, Chaput Jean-Philippe, Chastin Sebastien, Giangregorio Lora, Janssen Ian, Katzmarzyk Peter T, Kho Michelle E, Poitras Veronica J, Powell Kenneth E, Ross Robert, Ross-White Amanda, Tremblay Mark S, Healy Genevieve N,
Abstract
The purpose of this overview of systematic reviews was to determine the relationship between different types and patterns of sedentary behaviour and selected health outcomes in adults and older adults. Five electronic databases were last searched in May, 2019, with a 10-year search limit. Included reviews met the a priori population (community-dwelling adults aged 18 years and older), intervention/exposure/comparator (various types and/or patterns of sedentary behaviour), and outcomes criteria. Eighteen systematic reviews were included in the evidence synthesis. High levels of sedentary behaviour are unfavourably associated with cognitive function, depression, function and disability, physical activity levels, and physical health-related quality of life in adults. Reducing or breaking up sedentary behaviour may benefit body composition and markers of cardiometabolic risk. Total sedentary behaviour and TV viewing were most consistently associated with unfavourable health outcomes, while computer and Internet use may be favourably associated with cognitive function for older adults. The quality of evidence within individual reviews (as assessed by review authors) varied from low to high, while the certainty of evidence was low to very low. These findings have important public health implications, suggesting that adults should avoid high levels of sedentary behaviour and break-up periods of prolonged sitting. (PROSPERO registration nos.: CRD42019123121 and CRD42019127157.) High levels of sedentary behaviour are unfavourably associated with important health outcomes in adults. Reducing or breaking up sedentary behaviour may benefit body composition and markers of cardiometabolic risk. Computer and Internet use may be favourably associated with cognitive function in older adults.
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[The combined use of kinesio- and laser therapy in the regional hemodynamic disorders correction in dilated cardiomyopathy].
Vopr Kurortol Fizioter Lech Fiz Kult2020 ;97(5):13-21. doi: 10.17116/kurort20209705113.
Ismaylov I S, Mamedyarova I A, Baranov A V, Mustafaev R D, Lebedeva O D, Achilov A A,
Abstract
The search for new methods of symptomatic therapy of dilated cardiomyopathy (DCM) remains a relevant objective of modern cardiology. This is due to the low and short-term existing methods effectiveness of conservative and surgical treatment, including drug therapy.
PURPOSE OF THE STUDY:
Efficacy evaluation of the combined use of kinesio- and laser therapy for the correction of regional hemodynamics in patients with DCM against the background of maintenance drug therapy.
MATERIAL AND METHODS:
100 patients with DCM were examined. All patients received differential maintenance drug therapy (beta-blockers, ACE inhibitors, with intolerance to the latter - angiotensin II receptor blockers, aldosterone receptor antagonists, diuretics, cardiac glycosides, antiarrhythmic drugs). Patients were divided into 2 groups at least 3 months after the selection of drug therapy. Intravenous laser blood irradiation (ILBI) and the selection of unloading therapeutic exercises were performed for patients of the main group during therapy. Patients in the control group received only drug therapy. The main research method was venous occlusion plethysmography. It was used to assess regional hemodynamics with the determination of recirculating blood flow (Qr) and regional vascular resistance (Rr) at rest, venous tone (Vt), reserve blood flow (QH) and regional vascular resistance (RH) against a functional stress test.
RESULTS:
Data obtained in the dynamic observation process (after 1, 3, 6, 9 and 12 months) in the main group indicate a significant increase in Qr and QH, a decrease in Rr and RH, Vt. Significant positive dynamics in the control group was not observed. The regional hemodynamics indices after 9 and 12 months of observation significantly worsened.
CONCLUSION:
Thus, according to venous-occlusal plethysmography, the use of unloading therapeutic exercises in combination with ILBI against the background of rationally selected differentiated drug therapy in patients with DCM significantly improves the regional hemodynamics. The developed symptomatic therapy methods can be applied in the practice of cardiologists, general practitioners, therapeutists, rehabilitation physicians to optimize the treatment of patients with DCM.
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[Physical training integration with physiotherapeutic methods of myocardial metabolism recovery in the rehabilitation of patients after acute coronary syndrome and cardiosurgical myocardial revascularization].
Vopr Kurortol Fizioter Lech Fiz Kult2020 ;97(5):5-12. doi: 10.17116/kurort2020970515.
Knyazeva T A, Badtieva V A, Nikiforova T I,
Abstract
Successes achieved in the treatment of patients with coronary heart disease (CHD) after acute coronary syndrome and cardiosurgical interventions require the development of new, more advanced methods for their rehabilitation. This is because of metabolic disturbances persistence in the deeply ischemic myocardium in patients with coronary heart disease even after restoration of blood flow through the coronary arteries by surgical or endovascular methods due to the development of the phenomenon of «stunning» and hibernation. The discovery of the development of their own adaptation to ischemia phenomenon opens up new possibilities in the correction of the metabolism of the ischemic myocardium, which significantly increases the efficiency of patient postoperative rehabilitation.
PURPOSE OF THE STUDY:
The scientific rationale for improved cardiac rehabilitation programs for patients after acute coronary syndrome and cardiac surgery.
MATERIAL AND METHODS:
120 patients who were randomized to 3 groups (40 patients each) were examined: the main and two control, comparable in the major clinical manifestations of the disease. Improved methods of physical training with the inclusion of interval cyclic training for the first time in cardiology on treadmills and sensory tracks and therapeutic exercises in the gym (daily, 5 times a week, for a course of 10 procedures) were performed for patients of the 1st control group. Therapeutic procedures that improve metabolic processes in the ischemic myocardium were used in patients of the 2nd control group: enhanced external counterpulsation, general dry air carbon dioxide, infrared matrix laser therapy. Rehabilitation by the complex of the above physical training and factors which restored metabolic processes in the ischemic myocardium was carried out to patients of the main group. Methods had a cardioprotective effect and increase myocardial adaptation to ischemia.
RESULTS:
The greatest anti-ischemic, antianginal, antihypoxic effects were achieved in patients of the main group compared with the control groups. What may be due to the correction of metabolic disorders and the development of cardioprotection of ischemic myocardium. The consequence is a significant increase in the rehabilitation effect of improved cardiovascular training.
CONCLUSION:
The achieved result is due to the integration of improved cardiac training techniques and a procedure package aimed at cardioprotection and metabolic myocardium adaptation to ischemia, which included enhanced external counterpulsation, general dry air carbon dioxide and infrared matrix laser therapy.
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Effect of a 6-week and 12-week cardiac rehabilitation program on heart rate recovery.
Egypt Heart J2020 Oct;72(1):69. doi: 10.1186/s43044-020-00107-8.
El Missiri Ahmed, Amin Sameh Atteya, Tawfik Islam Reda, Shabana Adel Mohamed,
Abstract
BACKGROUND:
Cardiac rehabilitation has been shown to reduce cardiac mortality, improve quality of life, and reduce hospitalizations. Cardiac rehabilitation programs are usually performed over a 12-week period. Studies have shown that similar benefits could be achieved with shorter programs. Abnormal heart rate recovery after exercise has been associated with an increased risk of cardiovascular events and mortality. The main aim of this study was to compare the effect of a 6-week phase 2 cardiac rehabilitation program on heart rate recovery to a 12-week one in patients who had recovered from an anterior wall ST segment elevation myocardial infarction.
RESULTS:
This prospective study included 60 patients enrolled in cardiac rehabilitation programs randomized into two equal groups: a 6-week and a 12-week program. Baseline patient demographics, lipid profile, and left ventricular ejection fraction (LVEF) were assessed. METs achieved, total exercise time, resting heart rate, peak heart rate, and heart rate recovery at 1?min were examined. These were re-assessed at the end of each program. Results showed no difference between both groups at the end of each program regarding lipid profile and LVEF. Patients enrolled in the 12-week cardiac rehabilitation program were able to achieve more METs, had a longer exercise time, a higher peak heart rate, and had a lower resting heart rate at the end of the program. Heart rate recovery was slightly higher in patients enrolled in the 6-week program 26.5 ± 6.78 versus 23.17 ± 6.12?bpm (p = 0.051). On comparing the magnitude of change between both programs, those in the 12-week program had more increase in HDL-C levels, METs achieved, and exercise time. Additionally, they had more reduction of resting heart rate. Heart rate recovery was more increased for those in the 6-week program.
CONCLUSION:
Although heart rate recovery increases after completion of each of a 6-week and 12-week cardiac rehabilitation program compared to their baseline, there is no difference on comparing heart rate recovery between both programs at their end. Patients enrolled in a standard 12-week cardiac rehabilitation program achieve more METs, have a longer exercise time, a higher peak HR, and a lower resting HR at the end of the program compared to those in the 6-week program.
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Implementing a Pressure Injury Prevention Bundle to Decrease Hospital-Acquired Pressure Injuries in an Adult Critical Care Unit: An Evidence-Based, Pilot Initiative.
Wound Manag Prev2020 Oct;66(10):20-28.
Rivera Julie, Donohoe Erin, Deady-Rooney Mary, Douglas Maxine, Samaniego Nyishah,
Abstract
Patients in critical care units (CCUs) are at risk of the development of hospital-acquired pressure injuries (HAPIs). Research supports the use of a pressure injury prevention (PIP) bundle to standardize PIP strategies and reduce the incidence of HAPIs.
PURPOSE:
This evidence-based practice initiative was undertaken to implement a PIP bundle to decrease HAPIs in an adult patient CCU.
METHODS:
A literature review was conducted during the first month of the implementation of the initiative to identify best PIP and bundle implementation practices. Wound, ostomy, and continence nurses conducted educational sessions and mentored registered nurses who became PIP bundle resource nurses. Adoption of the bundle was validated using an audit tool and PIP rounds. The pre- and post-implementation HAPI indices, pressure injuries / patient care days × 1000, were compared.
RESULTS:
Implementation of the PIP bundle resulted in a notable decrease in HAPIs on the unit. During the pre-intervention period, January 2017 to January 2018, there were 9 HAPIs (HAPI index 3.4). During the 10-month post-intervention period, 1 HAPI developed (HAPI index 0.48).
CONCLUSION:
An evidence-based PIP bundle initiative was implemented in an adult patient CCU to standardize the process for HAPI prevention and reduce the number of HAPIs. Staff involvement and leadership support were vital to the success of the initiative. Integration of the bundle into practice resulted in a notable decrease in HAPIs.
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