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AIM: This paper is a report of a qualitative study conducted as part of a randomized controlled trial comparing a lay-facilitated angina management programme with usual care. Its aim was to explore participants' beliefs, experiences, and attitudes to the care they had received during the trial, particularly those who had received the angina management intervention. BACKGROUND: Angina affects over 50 million people worldwide. Over half of these people have symptoms that restrict their daily life and would benefit from knowing how to manage their condition. DESIGN: A nested qualitative study within a randomized controlled trial of lay-facilitated angina management. METHOD: We conducted four participant focus groups during 2008; three were with people randomized to the intervention and one with those randomized to control. We recruited a total of 14 participants to the focus groups, 10 intervention, and 4 control. FINDINGS: Although recruitment to the focus groups was relatively low by comparison to conventional standards, each generated lively discussions and a rich data set. Data analysis demonstrated both similarities and differences between control and intervention groups. Similarities included low levels of prior knowledge about angina, whereas differences included a perception among intervention participants that lifestyle changes were more easily facilitated with the help and support of a lay-worker. CONCLUSION: Lay facilitation with the Angina Plan is perceived by the participants to be beneficial in supporting self-management. However, clinical expertise is still required to meet the more complex information and care needs of people with stable angina.
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Angina de Pecho/tratamiento farmacológico , Fármacos Cardiovasculares/uso terapéutico , Grupos Focales , Humanos , Estilo de VidaRESUMEN
AIMS: This article reports a randomized controlled trial of lay-facilitated angina management (registered trial acronym: LAMP). BACKGROUND: Previously, a nurse-facilitated angina programme was shown to reduce angina while increasing physical activity, however most people with angina do not receive a cardiac rehabilitation or self-management programme. Lay people are increasingly being trained to facilitate self-management programmes. DESIGN: A randomized controlled trial comparing a lay-facilitated angina management programme with routine care from an angina nurse specialist. METHODS: Participants with new stable angina were randomized to the angina management programme (intervention: 70 participants) or advice from an angina nurse specialist (control: 72 participants). Primary outcome was angina frequency at 6 months; secondary outcomes at 3 and 6 months included: risk factors, physical functioning, anxiety, depression, angina misconceptions and cost utility. Follow-up was complete in March 2009. Analysis was by intention-to-treat; blind to group allocation. RESULTS: There was no important difference in angina frequency at 6 months. Secondary outcomes, assessed by either linear or logistic regression models, demonstrated important differences favouring the intervention group, at 3 months for: Anxiety, angina misconceptions and for exercise report; and at 6 months for: anxiety; depression; and angina misconceptions. The intervention was considered cost-effective. CONCLUSION: The angina management programme produced some superior benefits when compared to advice from a specialist nurse.
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Angina de Pecho/rehabilitación , Agentes Comunitarios de Salud , Manejo de Atención al Paciente/organización & administración , Autocuidado , Apoyo Social , Adulto , Anciano , Angina de Pecho/enfermería , Agentes Comunitarios de Salud/educación , Análisis Costo-Beneficio , Inglaterra , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermeras Clínicas , Manejo de Atención al Paciente/economía , Estudios Prospectivos , Análisis de Regresión , Método Simple Ciego , Resultado del TratamientoRESUMEN
AIM: This paper is a report of a study of the choices patients make when offered home-based or hospital-based cardiac rehabilitation. BACKGROUND: In some countries, patients may be offered a choice of home-based or hospital-based cardiac rehabilitation. While evaluating a home-based programme, Road to Recovery, developed by the British Heart Foundation, we examined patients' experiences of being offered this choice. METHODS: Interviews were conducted with 35 patients and 12 staff members delivering the pilot programme in five rehabilitation services during 2006-2008. FINDINGS: While the staff members interviewed reported that all patients were given a clear choice between a home-based and hospital-based or community-based programme, this choice was less clear-cut in the patient interviews. When choice was offered, the choice of a home-based programme was often based on constraints rather than on being a positive choice. Obstacles patients faced in making the choice included lack of information on which to base a choice; inadequate systems of referral; insufficient appropriately trained staff; restricted choice of times to attend the hospital programmes; the geographical location of services and restrictive socio-economic factors (inflexible working hours, access to transport). CONCLUSION: The possibility of informed choice relies in the first instance on the availability and accessibility of appropriate services. Nurses need awareness and commitment to finding out about and overcoming obstacles that impede patient participation in cardiac rehabilitation. Only in this manner will it be possible to fulfil the calls in national and some international clinical guidelines for 'individualized' or 'menu-based' programmes tailored to specific patient needs.
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Conducta de Elección , Enfermedad Coronaria/rehabilitación , Servicios de Atención de Salud a Domicilio , Aceptación de la Atención de Salud , Centros de Rehabilitación , Adulto , Anciano , Enfermedad Coronaria/prevención & control , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Investigación en Evaluación de Enfermería , Educación del Paciente como Asunto , Prioridad del Paciente , Investigación Cualitativa , Medicina Estatal/organización & administración , Reino UnidoAsunto(s)
Rehabilitación Cardiaca , Enfermedades Cardiovasculares/prevención & control , Prevención Secundaria/organización & administración , Enfermedades Cardiovasculares/epidemiología , Europa (Continente)/epidemiología , Práctica Clínica Basada en la Evidencia , Conductas Relacionadas con la Salud , Accesibilidad a los Servicios de Salud , Humanos , Evaluación de Programas y Proyectos de Salud , Conducta de Reducción del RiesgoRESUMEN
AIMS AND OBJECTIVES: To assess and compare misconceived and maladaptive beliefs about coronary heart disease between Taiwanese and British people with heart disease. BACKGROUND: Holding misconceived and maladaptive beliefs about heart disease has deleterious effects on a patient's quality of life. Cultural contexts influence a person's responses to illness, but little information exists about the ways in which cultural values influence a person's attributions and coping behaviours regarding their heart disease. DESIGN: A cross-sectional survey using a descriptive comparative design was carried out in Taiwan and Britain. METHODS: A structured questionnaire was used to elicit misconceived or potentially maladaptive beliefs about heart disease. People with a confirmed diagnosis of coronary heart disease were recruited from a teaching hospital in Taipei (n = 238) and a tertiary cardiothoracic centre in the North of England (n = 204). RESULTS: Taiwanese patients held more misconceived and maladaptive beliefs about heart disease than those in Britain. Both British and Taiwanese patients showed high agreement on 'stress is one of the main causes of heart disease' and 'always avoid stress', but these beliefs were more common in Taiwanese patients (p < 0.001). Misconceptions about avoiding anything that might bring on angina were common in both countries. CONCLUSIONS: While there were some similarities in the cardiac beliefs held by the two groups of patients, Taiwanese patients held significantly more misconceptions. This may be explained by differences between the patients' cultures, including social norms, health care provision and health information from the media. RELEVANCE TO CLINICAL PRACTICE: Interventions should be developed to dispel maladaptive beliefs thereby altering the coping actions of patients. The meaning and purpose of specific behaviours needs to be interpreted within the context of a patient's culture. Awareness of cultural perspectives may help to develop nursing care plans that are more successful as they are more individually applicable to patients.
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Cardiopatías/psicología , Adaptación Psicológica , Anciano , Anciano de 80 o más Años , Comparación Transcultural , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Taiwán , Reino UnidoRESUMEN
BACKGROUND: Many patients demonstrate psychological distress and reduced physical activity before coronary artery bypass graft surgery (CABG). Here we evaluated the addition of a brief, cognitive-behavioural intervention (the HeartOp Programme) to routine nurse counselling for people waiting for CABG surgery. METHODS: Randomised controlled trial comparing nurse counselling with the HeartOp programme to routine nurse counselling in 204 patients awaiting first time elective CABG. Primary outcome measures were: anxiety and length of hospital stay; secondary outcome measures were: depression, physical functioning, cardiac misconceptions and cost utility. Measures were collected prior to randomisation and after 8 weeks of their intervention prior to surgery, excepting length of hospital stay which was collected after discharge following surgery. RESULTS: 100 patients were randomised to intervention, 104 to control. At follow-up there were no differences in anxiety or length of hospital stay. There were significant differences in depression (difference=7.79, p=0.008, 95% CI=2.04-13.54), physical functioning (difference=0.82, p=0.001, 95%CI=0.34-1.3) and cardiac misconceptions (difference=2.56, p<0.001, 95%CI=1.64-3.48) in favour of the HeartOp Programme. The only difference to be maintained following surgery was in cardiac misconceptions. The HeartOp Programme was found to have an Incremental Cost Effectiveness Ratio (ICER) of pound 288.83 per Quality-Adjusted Life Year. CONCLUSIONS: Nurse counselling with the HeartOp Programme reduces depression and cardiac misconceptions and improves physical functioning before bypass surgery significantly more than nurse counselling alone and meets the accepted criteria for cost efficacy.
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Terapia Cognitivo-Conductual , Puente de Arteria Coronaria/enfermería , Depresión/terapia , Consejo Dirigido , Cuidados Preoperatorios , Adaptación Psicológica , Adulto , Anciano , Anciano de 80 o más Años , Intervalos de Confianza , Puente de Arteria Coronaria/psicología , Depresión/mortalidad , Depresión/prevención & control , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Complicaciones Posoperatorias/prevención & control , Psicometría , Años de Vida Ajustados por Calidad de Vida , Estrés Psicológico/etiología , Estrés Psicológico/enfermería , Estrés Psicológico/prevención & control , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
AIM: This paper is a report of a study to examine the misconceived and potentially maladaptive beliefs (cardiac misconceptions) about heart disease held by nurses, nursing students and people with heart disease in Taiwan. BACKGROUND: Research suggests that misconceived and maladaptive beliefs about heart disease influence outcomes in people with heart disease, and that eliciting and dispelling incorrect beliefs can reduce disability in this population. However, nurses do not routinely elicit maladaptive beliefs or attempt to dispel them. METHOD: Between October 2005 and March 2006, a survey was conducted using version 1 of the York Cardiac Beliefs Questionnaire to measure cardiac misconceptions in 64 hospital-based nurses (13 of whom were cardiac nurses), 134 nursing students and 238 people with heart disease. RESULTS: Nursing students held fewer cardiac misconceptions than nurses (P = 0.042). There were no statistically significant differences in the numbers of misconceptions between cardiac and general nurses, and no statistically significant associations between level of qualification, years of nursing experience and number of misconceptions. Nurses with higher levels of education were more likely to hold fewer misconceptions (P = 0.24). Patients held statistically significantly more misconceptions about heart problems than nurses (P < 0.001). CONCLUSION: Nurses who are involved in the care for people with heart disease have a responsibility to assess and dispel people's misconceptions about their condition, and therefore continuing professional education is required to develop this clinical expertise. Future research should focus on methods of dispelling cardiac misconceptions in both nursing and patient education.
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Conocimientos, Actitudes y Práctica en Salud , Cardiopatías/enfermería , Enfermeras y Enfermeros/psicología , Estudiantes de Enfermería/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Taiwán/epidemiología , Adulto JovenRESUMEN
Chronic refractory angina is an increasingly prevalent, complex chronic pain condition, which results in frequent hospitalization for chest pain. We have previously shown that a novel outpatient cognitive-behavioral chronic disease management program (CB-CDMP) improves angina status and quality of life in such patients. In the present study of 271 chronic refractory angina patients enrolled in our CB-CDMP, total hospital admissions were reduced from 2.40 admissions per patient per year to 1.78 admissions per patient per year (P<0.001). The rising trend of total hospital bed day occupancy prior to enrollment fell from 15.48 days per patient per year to a stable 10.34 days per patient per year (P<0.001). There were 32 recorded myocardial infarctions prior to enrollment compared to eight in the year following enrollment (14% vs. 2.3%, P<0.001) and overall mortality was lower that comparable groups treated with surgery. This study shows that educating patients and demystifying angina using a brief outpatient CB-CDMP produces an immediate and sustained reduction in hospital admission costs that represents a major potential health care saving. This benefit accrues in addition to the known effects of CB-CDMP on symptoms and quality of life. These data suggest that a CB-CDMP approach to symptom palliation represents a low cost alternative to palliative revascularization.
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Atención Ambulatoria , Angina de Pecho/terapia , Terapia Cognitivo-Conductual , Dolor Intratable/terapia , Admisión del Paciente/estadística & datos numéricos , Adulto , Anciano , Angina de Pecho/mortalidad , Estudios de Cohortes , Femenino , Humanos , Masculino , Auditoría Médica , Persona de Mediana Edad , Infarto del Miocardio/mortalidad , Infarto del Miocardio/prevención & control , Evaluación de Programas y Proyectos de SaludRESUMEN
OBJECTIVE: To assess a novel method for assessing risk and providing advice about activity to children and young people with congenital cardiac disease and their parents. DESIGN AND SETTING: Questionnaire survey in outpatient clinics at a tertiary centre dealing with congenital cardiac disease, and 6 peripheral clinics. INTERVENTIONS: Children or their parents completed a brief questionnaire. If this indicated a desire for help, or a serious mismatch between advised and real level of activity, they were telephoned by a physiotherapist. MAIN MEASURES OF OUTCOME: Knowledge about appropriate levels of activity, and identification of the number exercising at an unsafe level, the number seeking help, and the type of help required. RESULTS: 253/258 (98.0%) questionnaires were returned, with 119/253 (47.0%) showing incorrect responses in their belief about their advised level of exercise; 17/253 (6.7%) had potentially dangerous overestimation of exercise. Asked if they wanted advice 93/253 (36.8%) said "yes", 43/253 (17.0%) "maybe", and 117/253 (46.2%) "no". Of those contacted by phone to give advice, 72.7% (56/77) required a single contact and 14.3% (11/77) required an intervention that required more intensive contact lasting from 2 up to 12 weeks. Of the cohort, 3.9% (3/77) were taking part in activities that put them at significant risk. CONCLUSIONS: There is a significant lack of knowledge about appropriate levels of activity, and a desire for further advice, in children and young people with congenital cardiac disease. A few children may be at very significant risk. These needs can be identified, and clinical risk reduced, using a brief self-completed questionnaire combined with telephone follow-up from a suitably knowledgeable physiotherapist.
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Actividades Cotidianas/psicología , Competencia Clínica/normas , Cardiopatías Congénitas/psicología , Educación del Paciente como Asunto , Asunción de Riesgos , Encuestas y Cuestionarios/normas , Adolescente , Instituciones de Atención Ambulatoria , Niño , Femenino , Estudios de Seguimiento , Cardiopatías Congénitas/terapia , Humanos , Masculino , Relaciones Médico-Paciente , Pronóstico , Procesos Psicoterapéuticos , Estudios Retrospectivos , Medición de RiesgoRESUMEN
BACKGROUND: Provision of cardiac rehabilitation is inadequate in all countries in which it has been measured. This study assesses the provision in the United Kingdom and the changes between 1998 and 2004. METHODS: All UK cardiac rehabilitation programmes were surveyed annually. Figures for each year were up-rated to account for missing data and compared with national data for acute myocardial infarction, coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). The total numbers and percentage of eligible patients included were charted for 7 years. RESULTS: For centres giving figures, the total number treated rose from 29,890 in 1998 to 37,129 in 2004. The up-rated figures show that the percentage of eligible patients enrolled rose from 25.0% in 1998 to 31.5% in 1999 and has changed little since, falling from 31.3% in 2002 to 28.5% in 2004. About 25% of myocardial infarction patients, 75% of CABG patients and 20% of PCI patients joined cardiac rehabilitation programmes. CONCLUSIONS: The National Service Framework for Coronary Heart Disease set a target for 85% of myocardial infarct and coronary revascularization patients to be enrolled in rehabilitation programmes. Only one-third of this number is currently being enrolled and the percentage is falling.
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Angioplastia Coronaria con Balón/rehabilitación , Instituciones Cardiológicas/estadística & datos numéricos , Puente de Arteria Coronaria/rehabilitación , Infarto del Miocardio/rehabilitación , Centros de Rehabilitación/estadística & datos numéricos , Instituciones Cardiológicas/organización & administración , Instituciones Cardiológicas/provisión & distribución , Análisis Costo-Beneficio , Encuestas de Atención de la Salud , Hospitales Públicos , Humanos , Infarto del Miocardio/cirugía , Infarto del Miocardio/terapia , Centros de Rehabilitación/organización & administración , Centros de Rehabilitación/provisión & distribución , Medicina Estatal , Encuestas y Cuestionarios , Reino Unido/epidemiologíaRESUMEN
OBJECTIVE: The aim of this study was to examine the extent to which illness perceptions predict attendance at cardiac rehabilitation and quality of life following myocardial infarction (MI). METHODS: The illness perceptions of 194 MI patients were assessed whilst the patients were still in hospital following an MI. The mean age was 63.3 years (S.D. = 10.6), and 142 of the patients were men. Cardiac rehabilitation attendance and quality of life were assessed via a postal questionnaire 6 months later. RESULTS: In contrast to previous work reported in this area, illness perceptions were not significantly associated with attendance at cardiac rehabilitation. Illness perceptions measured within 24 h of an acute MI were predictive of quality of life 6 months later. CONCLUSION: Previous reports may have overestimated the extent to which illness perceptions predict attendance at cardiac rehabilitation. The relationship between illness perceptions and quality of life at 6 months suggests that interventions to alter illness perceptions, especially perceptions of consequences, may be useful in improving health-related quality of life (HRQoL) following an MI.
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Actitud Frente a la Salud , Infarto del Miocardio/psicología , Infarto del Miocardio/rehabilitación , Cooperación del Paciente , Calidad de Vida , Anciano , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Percepción , Estudios Prospectivos , Terapia por RelajaciónRESUMEN
OBJECTIVE: The aim of this study is to examine the association between changes in misconceived or maladaptive beliefs about angina and patients' functional and psychological status. METHOD: The method used was a prospective follow-up study over 1 year of 133 people with angina. RESULTS: Beliefs about angina were significantly associated with functional and psychological status. People with more misconceived or maladaptive beliefs were more anxious and physically limited than were people with fewer such beliefs, with differences in physical functioning that were clinically significant. Change in angina beliefs over 1 year was the most significant predictor for physical functioning at follow-up, after controlling for the effects of demographic variables and the outcome variable at baseline, whereas change in the frequency of angina did not contribute significantly to this model. CONCLUSION: Misconceived and maladaptive beliefs about angina are associated with reductions in both functional and psychological status. These beliefs are easily and quickly identified using a simple questionnaire and should be corrected.
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Angina de Pecho/complicaciones , Angina de Pecho/psicología , Ansiedad , Actitud Frente a la Salud , Conocimiento , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estado de Salud , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
It is known that people who have suffered a heart attack can hold misconceived or maladaptive beliefs and that these can have a deleterious effect on quality of life and functioning. It has also been noted that clinicians do not routinely elicit these maladaptive beliefs. It is probable that angina sufferers also hold such beliefs. As angina is a great burden in the western world, with over two million people with angina in the UK alone, there may be large numbers of people who suffer from these frightening and unhelpful misconceptions. We believe that there is a need for a simple questionnaire that could assist the delivery of tailored education directed at dispelling common misconceptions. This article details the development and psychometric properties of just such a brief questionnaire, designed for use both in research and in clinical practice.
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Actividades Cotidianas/psicología , Angina de Pecho/psicología , Actitud Frente a la Salud , Educación en Salud , Infarto del Miocardio/psicología , Calidad de Vida/psicología , Encuestas y Cuestionarios , Adaptación Psicológica , Adulto , Anciano , Anciano de 80 o más Años , Inglaterra , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Inventario de Personalidad/estadística & datos numéricos , Psicometría/estadística & datos numéricos , Reproducibilidad de los Resultados , Rol del EnfermoRESUMEN
The utility of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for coronary care patients following acute myocardial infarction (MI) was investigated. A confirmatory factor analysis was conducted on the HADS to determine its psychometric properties in 335 MI patients over three observation points (1 week, 6 weeks and 6 months). Internal and test-retest reliabilities of the HADS total and HADS sub-scale scores were generally found to be acceptable. The underlying factor structure of the HADS comprised three distinct factors. Support was found for the use of the HADS sub-scales to assess dimensions of anhedonia, psychic anxiety and psychomotor agitation. The HADS may be a useful screening instrument to assess post-MI patients for symptoms of psychological distress. Further research is required to determine the three-factor structure of the HADS in other clinical groups.
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Ansiedad/diagnóstico , Depresión/diagnóstico , Infarto del Miocardio/psicología , Inventario de Personalidad/estadística & datos numéricos , Rol del Enfermo , Anciano , Anciano de 80 o más Años , Ansiedad/psicología , Unidades de Cuidados Coronarios , Depresión/psicología , Inglaterra , Femenino , Estudios de Seguimiento , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Infarto del Miocardio/rehabilitación , Psicometría/estadística & datos numéricos , Agitación Psicomotora/diagnóstico , Agitación Psicomotora/psicología , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND AND PURPOSE: There is little documented evidence of young people with congenital cardiac disease being consulted as to what help, if any, they really need in relation to their condition. Most research concentrates on the medical aspects of the condition. There are studies of psychological and social functioning, but few have directly sought the opinions of the young people. More recent research has indicated a need for health professionals to develop services to meet both psychosocial and physical needs of young people with congenital cardiac disease. The findings of the recent Kennedy Report support this need. The purpose of this study was to explore the views of young people with a range of congenital cardiac conditions, on what would help them better deal with their condition, and when and how help might be provided. METHODS: This was a qualitative study using semi-structured interviews. We interviewed 16 young people in their own home. Interviews were tape-recorded and transcribed. Analysis was conducted using the "Framework" method. RESULTS: Whilst most of the young people interviewed actively manage their condition, they think more support from others would be beneficial. Issues of activity and communication were cited most often as areas requiring more understanding from people they interact with, for example teachers and peers. The discussion focuses on how health professionals might change or develop their practice to help young people better cope with their condition. CONCLUSIONS: Most of the young people interviewed in this study had developed their own strategies for coping with their condition. Although this is a small study, the young people provided important suggestions as to how health professionals could better develop current services.
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Servicios de Salud del Adolescente/normas , Procedimientos Quirúrgicos Cardíacos/rehabilitación , Servicios de Salud del Niño/normas , Niños con Discapacidad/psicología , Cardiopatías Congénitas/psicología , Cardiopatías Congénitas/cirugía , Satisfacción del Paciente , Calidad de Vida , Adaptación Psicológica , Adolescente , Servicios de Salud del Adolescente/tendencias , Procedimientos Quirúrgicos Cardíacos/métodos , Niño , Defensa del Niño , Servicios de Salud del Niño/tendencias , Femenino , Cardiopatías Congénitas/diagnóstico , Humanos , Relaciones Interpersonales , Estilo de Vida , Masculino , Aptitud Física , Muestreo , Grupos de Autoayuda , Índice de Severidad de la Enfermedad , Ajuste Social , Encuestas y Cuestionarios , Reino UnidoRESUMEN
BACKGROUND AND PURPOSE: Although much previous research has focused on the medical aspects of congenital cardiac disease, there is a growing body of research which suggests that families may need help and support with the wider issues associated with the medical condition. We have previously ascertained from young people with congenital cardiac disease their views on this subject. The purpose of this study was to obtain the views of their parents about the need for, and shape of, services for rehabilitation. METHODS: This was a qualitative study using semi-structured interviews. We interviewed 17 parents in their own home. Interviews were tape-recorded and transcribed. RESULTS: Parents would welcome more help and support from health professionals to enable them to manage more effectively the condition with their children. Particular areas of concern relate to the information they receive about the condition; communication between themselves and health professionals; establishing safe levels of activity; and managing the condition at school. CONCLUSIONS: This is a small study of the experiences and views of parents, which provides some important information on ways in which health professionals could address the current lack of services for rehabilitation.
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Actividades Cotidianas , Procedimientos Quirúrgicos Cardíacos/rehabilitación , Cardiopatías Congénitas/rehabilitación , Padres/psicología , Planificación de Atención al Paciente , Relaciones Profesional-Familia , Calidad de Vida , Adaptación Psicológica , Adolescente , Procedimientos Quirúrgicos Cardíacos/métodos , Niño , Preescolar , Comportamiento del Consumidor , Niños con Discapacidad , Femenino , Cardiopatías Congénitas/cirugía , Humanos , Cuidados a Largo Plazo , Masculino , Evaluación de Necesidades , Relaciones Padres-Hijo , Muestreo , Índice de Severidad de la Enfermedad , Apoyo Social , Encuestas y Cuestionarios , Reino UnidoRESUMEN
A postal questionnaire survey of the 17 centres for paediatric cardiology in the UK investigated the attitudes of staff towards rehabilitation and the current level of provision. The majority of respondents (82%) believed they should provide rehabilitation for their patients, but only one centre had a programme for rehabilitation. Few respondents (18%) believed they were meeting the needs of their patients' for rehabilitation. Major barriers to providing rehabilitation were funding and the wide geographical catchment areas.
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Servicios de Salud del Adolescente/organización & administración , Servicios de Salud del Niño/organización & administración , Cardiopatías Congénitas/rehabilitación , Centros de Rehabilitación/organización & administración , Adolescente , Niño , Humanos , Encuestas y Cuestionarios , Reino UnidoRESUMEN
PURPOSE: This study aimed to establish the reliability, validity, and sensitivity of the Cardiovascular Limitations and Symptoms Profile (CLASP) in a group of patients with chronic stable angina. METHODS: After 226 patients with angina had been recruited, they were randomly allocated to one of three groups: a 10-week hospital-based angina management program (n = 75; men = 56; age = 60 +/- 8 years), routine care (n = 74; men = 52; age = 61 +/- 7 years), and exercise therapy (n = 77; men = 60; age = 60 +/- 7 years). All the patients were assessed with CLASP on two occasions: at baseline and at 10 weeks. The Sickness Impact Profile (SIP), the Hospital Anxiety and Depression Scale (HADS), and the Sleep Problems Questionnaire (SPQ) also were administered at the same time. RESULTS: Significant positive correlations between the actual number of angina episodes and the CLASP angina subscale scores (r =.60, P <.001) were observed. The CLASP subscale scores for shortness of breath (r = -.36; P <.001) and ankle swelling (r = -.24; P <.001) were significantly correlated with the total treadmill time. The CLASP tiredness subscale score showed a significant positive correlation with the SPQ score (r =.48; P <.001). The CLASP subscale scores were significantly correlated with their corresponding SIP subscale scores: the tiredness score with the sleep and rest score (r =.49; P <.001), the social and leisure score with the recreation and pastimes score (r =.41; P <.001), the home score with the home management score (r =.45; P <.001), and the mobility score with the mobility (r =.37; P <.001) and total treadmill time scores (r = -.49; P <.001). CONCLUSIONS: The findings show CLASP to be a reliable, valid, sensitive measure of health-related quality of life in patients with chronic stable angina. Before it can be recommended for all patients with heart disorders, similar data will be required from other diagnostic groups such as patients with heart failure or those who have sustained an acute myocardial infarction.
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Angina de Pecho/rehabilitación , Evaluación de Resultado en la Atención de Salud , Perfil de Impacto de Enfermedad , Anciano , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Calidad de VidaRESUMEN
OBJECTIVE: To identify the themes that influence decision making processes used by patients with symptoms of acute myocardial infarction. DESIGN: Qualitative study using semistructured interviews. SETTING: Two district hospitals in North Yorkshire. PARTICIPANTS: 22 patients admitted to hospital with confirmed second, third, or fourth acute myocardial infarction. MAIN OUTCOME MEASUREMENTS: Patients' perceptions of their experience between the onset of symptoms and the decision to seek medical help. RESULTS: Six main themes that influence the decision making process were identified: appraisal of symptoms, perceived risk, previous experience, psychological and emotional factors, use of the NHS, and context of the event. CONCLUSIONS: Knowledge of symptoms may not be enough to promote prompt action in the event of an acute myocardial infarction. Cognitive and emotional processes, individual beliefs and values, and the influence of the context of the event should also be considered in individual interventions designed to reduce delay in the event of symptoms of acute myocardial infarction.