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Background and Aim: Sexual health and sexual quality of life are key components of psychosocial adjustment after cardiac surgeries and are often linked with improving the general quality of life. Reviews have been conducted to highlight the associations between cardiovascular diseases and sexual dysfunctions, but no review reported determinants of sexual health and sexual quality of life in patients after cardiovascular surgeries. We aimed to comprehensively examine the determinants of sexual health and sexual quality of life among individuals with cardiovascular surgeries., Methods: Literature was searched within PubMed, CINAHL, Scopus, Web of Science, and OVID databases. In total, 816 records were identified from database searches, 279 records were screened, and 11 empirical studies were included for review. Relevant data were extracted using literature summary tables and synthesised using an inductive approach., Results: The core determinants of sexual health and sexual quality of life were type of surgery and comorbidities, fears and uncertainties regarding sexual activity, sexual health education and counselling, spousal relationship and communication, and demographic factors such as advanced age and literacy levels. Major surgeries performed were coronary artery bypass grafting (CABG) and heart valve surgeries. The data collection tools used to collect data for sexual health and sexual quality of life were the International Erectile Function Questionnaire (IEFQ), International Index of Erectile Function (IIEF), Female Sexual Function Index (FSFI), Sexual Knowledge CABG Scale (SKS-CABG), Sexual Quality of Life Questionnaire (SQOL), SKS-Myocardial Infarction Scale (SKS-MI), and Couple Communication Scale (CCS)., Conclusions: Despite their importance, sexual health and quality of life are frequently overlooked during patient rehabilitation after cardiovascular surgeries. The lack of adequate education and counselling from healthcare professionals frequently leads to increased fear and uncertainties among individuals and their partners. Therefore, more person-centred educational and counselling approaches should be developed to address the sexual concerns of individuals and their partners., Competing Interests: Conflict of Interest The authors report there are no competing interests to declare., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Surgical procedures cause a certain level of anxiety in the relatives of the patients, it has been observed that heart surgeries cause more anxiety., Aim: To determine the effects of informing patients' relatives with short messages on anxiety levels during cardiovascular surgery., Methods: The study was conducted as a randomized controlled research investigation from October 1, 2015, to December 31, 2022, at the cardiovascular surgery operating room of a university hospital and included 84 patient relatives (42 experimental and 42 control group). The Patient Relatives Information Form and the State and Trait Anxiety Inventory were used to collect the study data. The patients' relatives in the experimental group were informed by short messages (preparations for surgery have begun, your relative's surgery has started, your relative's surgery is still ongoing, and your relative's surgery is completed) during the surgery. State Anxiety Inventory was re-administered to all patients' relatives after cardiovascular surgery. The study was registered with ClinicalTrials.gov (NCT05157789)., Results: It was found that the postoperative State Anxiety Inventory score of the experimental group was significantly lower than that of the control group (P < 0.001). The difference between preoperative and postoperative state anxiety scores was significantly higher in the experimental group (P < 0.001)., Conclusion: Informing the patients' relatives with a short message during cardiovascular surgery significantly reduced the level of anxiety., (Copyright © 2024 Copyright: © 2024 Nigerian Journal of Clinical Practice.)

Background: This qualitative research explored the lived experiences of patients who experienced postponement of elective cardiac and vascular surgery due to coronavirus disease 2019 (COVID-19). We know very little about patients during the novel coronavirus pandemic. Understanding the patient voice may play an important role in prioritization of postponed cases and triage moving forward., Methods: Utilizing a hermeneutical phenomenological qualitative design, we interviewed 47 individuals who experienced a postponement of cardiac or vascular surgery due to the COVID-19 pandemic. Data were analyzed and informed by phenomenological research methods., Results: Patients in our study described 3 key issues around their postponement of elective surgery. Patients described robust narratives about the meanings of their elective surgeries as the chance to "return to normal" and alleviate symptoms that impacted everyday life. Second, because of the meanings most of our patients ascribed to their surgeries, postponement often took a toll on how patients managed physical health and emotional well-being. Finally, paradoxically, many patients in our study were demonstrative that they would "rather die from a heart attack" than be exposed to the coronavirus., Conclusions: We identified several components of the patient experience, encompassing quality of life and other desired benefits of surgery, the risks of COVID, and difficulty reconciling the 2. Our study provides significant qualitative evidence to inform providers of important considerations when rescheduling the backlog of patients. The emotional and psychological distress that patients experienced due to postponement may also require additional considerations in postoperative recovery., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: Competing interests: None declared.

The COVID-19 pandemic has led to significant morbidity and mortality globally. As health systems grapple with caring for patients affected with COVID-19, cardiovascular procedures that are deemed 'elective' have been postponed. Guidelines concerning which cardiac procedures should be performed during the pandemic vary by specialty and geography in the USA. We propose a clinical heuristic to guide individual physicians and governing bodies in their decision making regarding which cardiac procedures should be performed during the COVID-19 pandemic using the behavioural economics concept of heuristics and ecological rationality., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Intensive care units are stressful places where patients experience physical and psychological discomfort. Understanding the experience of these patients regarding nursing care is very important., Aims and Objectives: To determine the intensive care experiences of thoracic and cardiovascular surgery patients and the factors that affect them., Design: The research consists of two phases: quantitative and qualitative., Methods: This was a descriptive and cross-sectional study. Its research sample comprised 100 patients who spent at least one night in an intensive care unit after thoracic or cardiovascular surgery. The Intensive Care Experiences Scale (ICES) and the Numeric Rating Scale were used. Two open-ended questions were asked to the patients to understand what they felt when they were attached to mechanical ventilation and to describe their intensive care experiences., Results: The ICES mean score was 66.35 ± 6.88. Significant negative relationships were found between length of stay and severity of pain and ICES total scores. A significant difference was found between scale scores and being understood by health care professionals when attached to mechanical ventilation. The patients stated that, when they were attached to mechanical ventilation and during their stay in the intensive care unit, they experienced feelings of helplessness, uncertainty, and fear. They also experienced physical discomfort and reported no longer fearing death., Conclusion: It was determined that patients partially positively perceived their experiences. It was found that they focused on coming out of surgery alive. The physical discomfort and negative emotions reported can be reduced or relieved by competent care., Relevance to Clinical Practice: The intensive care experiences and emotions of intensive care patients are important. Physical discomfort and negative emotions can be mitigated or alleviated by competent nursing care., (© 2019 British Association of Critical Care Nurses.)

Aim: To explore patients' with complex aortic diseases lived experiences of recovery between and after staged endovascular aortic repair (EVAR) procedures, including adjunctive open surgery., Design: Qualitative descriptive phenomenological design, applying person-centred care and lifeworld-led health care., Methods: Patients operated on in a staged fashion between 2012-2017 were invited to participate. Six participants underwent in-depth interviews 1-5 years postoperatively. The interviews were analysed using descriptive phenomenological method., Findings: The essence of the patients' experiences was described as: a necessary, overwhelming, hard, and prolonged process with life changing consequences. Between the operations: expected tiredness where life goes on as usual and insufficient time for recovery. Short-term after all operations: overwhelming tiredness, pain and complications, mostly from neurological deficits. Losing 'yourself' and struggling to manage daily life one day to another. Long-term after all operations: gradually recovering back to 'yourself' and having to accept life with permanent setbacks and limitations., Conclusion: Patients with complex aortic diseases struggle with physical and psychological setbacks, continuing years after their operations. There is a need to prospectively assess different aspects of these patients' recovery, identify those with impaired recovery and establish preventive and supporting strategies., Impact: Patients' experience of recovery after staged aortic repair has not previously been investigated. The findings indicate that these patients struggle with various physical and psychological setbacks continuing years after their operations. These results will inform further research on this group of patients and guide healthcare professionals in the care of these patients in their transition back to recovery., (© 2019 John Wiley & Sons Ltd.)

Background: The objectives of this study are to validate the Quality of Life in Cardiovascular Surgery (QLCS) questionnaire and to observe the evolution of quality of life in the first year of postoperative follow-up of patients who underwent coronary artery bypass grafting (CABG)., Methods: This was a prospective observational study of patients undergoing CABG from July 2016 to June 2017 who survived and answered the QLCS with 1, 6, and 12 months of follow-up. Validation was evaluated for internal consistency by Cronbach's alpha, test-retest reproducibility by correlation coefficient of concordance, and accuracy for interrater reliability by the kappa statistic. The nonparametric analysis of variance test was used for analysis of repeated measures, during follow-up, of the QLCS was considered significant at p < 0.05., Results: Included were 360 patients, with a mean age of 63 years; 72% were men. Cronbach's alpha was 0.82, demonstrating adequate internal consistency. The correlation coefficient of concordance was 0.93 and accuracy 0.99, showing good precision and accuracy. The kappa statistic for questions ranged from 0.58 to 0.78, which ensures a moderate reproducibility. Scores of the QLCS in patients undergoing CABG of 17.69, 18.82, and 19.52 were found at 1, 6, and 12 months, respectively. Thus there was a progressive improvement in quality of life over the first year of follow-up (p < 0.0001)., Conclusions: The QLCS proved to be a good questionnaire in this population, with adequate internal consistency and moderate reproducibility. Its use revealed a progressive and significant improvement in the quality of life of patients undergoing CABG., (Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Aim: To appraise the evidence concerning the effect of reflexology on the anxiety in patients undergoing cardiovascular interventional procedures., Background: Anxiety, fear, and other unpleasant emotional experiences are common among patients before and after cardiovascular interventional procedures. The higher anxiety may affect prognosis and recovery of patients., Design: A systematic review and meta-analysis., Data Sources: The MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Central Register of Controlled Trials (Cochrane Library), EMBASE, PsycINFO, and Web of Science were searched between 2001-2017., Review Methods: Randomized controlled trials evaluated the effectiveness of reflexology on anxiety among patients undergoing cardiovascular interventional procedures were included. Meta-analysis was done using Revman 5.3., Results: Ten trials, representing 760 patients with the mean age of 59, fulfilled the inclusion criteria. Reflexology significantly decreased the anxiety of patients undergoing cardiovascular interventional procedures in the treatment group compared with the control group., Conclusion: Reflexology has some positive effects on anxiety among patients undergoing cardiovascular procedures. It may be a useful complementary therapy and further research is necessary to create reliable evidence., (© 2018 John Wiley & Sons Ltd.)

Objective: Elaboration and internal validation of the Quality of Life in Cardiovascular Surgery (QLCS) questionnaire adapted to the reality of Brazilian cardiovascular surgery., Methods: Cross-sectional pilot study of a prospective cohort included in the Documentation and Surgical Registry Center (CEDREC) for internal validation of the QLCS questionnaire. Four hundred forty-five patients submitted to cardiovascular surgery and who answered a QLCS questionnaire 30 days after hospital discharge were included. It was applied via telephone. To verify the questions' internal consistency, Cronbach's alpha was used. The total QLCS score was calculated as the sum of 5 questions, ranging from 5 to 25 points. Mann-U-Whitney test was used to relate the symptoms with the quality of life (QoL). Level of significance was 5%., Results: After 30 days of surgery, about 95% of the patients had already returned to normal routine and 19% of them were already performing physical activity. In the evaluation of the QLCS's internal consistency, a Cronbach's alpha of 0.74 was found, suggesting that this was probably an adequate questionnaire to evaluate QoL in this population. In the comparison between the presence and absence of symptoms and the median of QoL, the presence of pain at the incision (P=0.002), chest pain (P<0.001), shortness of breath (P<0.001), and return to physical activity (P<0.001) were statistically significant., Conclusion: The process of elaboration and validation of questionnaires includes a series of steps. The QLCS questionnaire is probably an adequate tool for the evaluation of QoL in the postoperative patient of cardiovascular surgery, in this first stage of internal validation.

For many years, the therapy field was dominated by a focus on the past. In this context, many clinicians were trained to use hypnosis as a tool to explore the past, and there is a rich literature documenting the use of hypnosis as a tool to induce age regression and the uncovering of traumatic memories. This article presents a therapeutic paradigm that focuses on the future. Hypnosis is used to induce creativity, flexibility, and openness to the future. In the context of health care, hypnosis is used to explore the best possible treatment outcome, which may be pharmacological, surgical, or a combination of both as well as other nonsurgical interventions. This article elaborates on the effective use of a therapeutic hypnosis strategy and technique focused on the future.

It was when a patient with a type A aortic dissection refused surgical treatment that our eyes were opened to the importance of shared decision-making (SDM). As these patients are usually transferred to the operating theatre without any opportunity for discussion about the indication for surgery, our department of cardiothoracic surgery rapidly became keen on applying the principles of SDM to all our patient contacts - as did other departments in our hospital. However, when I became a patient myself and was invited by my physicians to take part in the decision-making process about my treatment, I was surprised to find that I felt very reluctant to do so and preferred to be not involved at all. The various reasons I raised to explain this unexpected behaviour made good sense. Consequently, in my daily practice if a patient evidently does not want to take part in SDM, I now compassionately offer to make decisions myself without requiring their involvement.

Background: Parents of infants admitted to the Neonatal Intensive Care Unit (NICU) are at risk of psychological distress and NICU-related stress. However, parents of infants admitted to NICU for cardiac surgery are an under-researched population., Aims: Identify levels of NICU-related stress, and levels of psychological distress, reported by parents of infants admitted to the NICU for cardiac surgery., Study Design: Observational study., Subjects: 69 parents of infants admitted to the NICU for cardiac surgery (cardiac group) and 142 parents of healthy infants (control group)., Outcome Measures: Questionnaire packs provided to parents prior to discharge (time-point 1), and at six and 12months corrected age included: Hospital Anxiety and Depression Scale, Coping Inventory for Stressful Situations, and Family Support Scale. The Parental Stressor Scale:NICU was administered to the cardiac group at time-point 1., Results: The cardiac group reported (i) that parental role alteration was the most stressful aspect of the NICU and (ii) higher scores for anxiety and depression than the control group at all three time-points, with the highest levels reported during the NICU stay. Correlation analyses indicated (i) stress associated with the sights and sounds of the NICU, and the appearance and behaviour of the infant in the NICU, had a significant positive association with anxiety and depression, and (ii) a significant negative relationship between anxiety and task-focused coping., Conclusions: An individualised parent-targeted intervention aimed at reducing stress associated with the NICU and enhancing task-focused coping style may help to reduce levels of anxiety and depression within this group of parents., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

The purpose of this study was to describe the experiences of postoperative cardio-thoracic surgical patients experiencing nursing bedside handover. A descriptive qualitative approach was undertaken. A purposeful sampling technique was adopted, including 14 patients who went through cardio-thoracic surgery and witnessed at least two bedside handovers. The study was performed in a Cardio-thoracic ICU localised in a Joint Commission International accredited Academic Hospital in north-eastern Italy from August to November 2014. The experience of patients participating at the bedside handover is based on four main themes: (1) 'discovering a new nursing identity', (2) 'being apparently engaged in a bedside handover', (3) 'experiencing the paradox of confidentiality' and (4) 'having the situation under control'. With the handover performed at the bedside in a postoperative setting, two interconnected potential effects may be achieved with regard to patients, nurses and the nursing profession. Nurses have a great opportunity to express their closeness to patients and to promote awareness of the important growth that nursing has achieved over the years as a profession and discipline. Therefore, patients may better perceive nursing competence and feel safer during the postoperative care pathway. They can appreciate nurses' humanity in caring and trust their competence and professionalism., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Aims: To assess the functional status and the family impact of children with congenital heart defects (CHD), using the parental Functional Status II (FS-II) and the Impact on Family (IOF) questionnaires., Methods: In this prospective observational study, parents of children who underwent surgery for CHD during the first year of life completed the FS-II and the IOF questionnaires. Genetic syndromes and prematurity <32weeks were exclusion criteria. The FS-II generates a total score and age specific general health (GH), activity (A) and, responsiveness (R) subscales. The IOF generates a total scale and financial and sibling subscales., Results: Our cohort (n=100), comprised 54% males; the median (IQR) age was 32 (10-56) months. Eighteen children had age-specific scores in the 1-2 SD below mean range (n=17) or more than 2 SD below the mean (n=1) for "ill children". There were significant negative correlations between the total FS-II and total IOF (r=-0.35, p<0.001) and financial IOF (r=-0.35, p<0.001). RACHS-1 category of CHD 4-6 was associated with higher likelihood of lower functional status., Conclusions: More complex CHD was associated with lower functional status, which correlated with a greater impact on the families. Parental questionnaires may be useful instruments for developmental surveillance in this population., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Purpose: The study was planned to review the experiences of patients in the intensive care units (ICUs) and determine their states of awareness following an emergency or elective cardiac surgery., Materials and Methods: This was a multicenter and descriptive study. Approval was granted by the Institutional Ethics Committee and informed consent for participation in the study was obtained from all the patients. The study included a total of 300 patients who underwent emergency or elective cardiovascular surgery and were then transferred to the ICU. Data were gathered from the demographic data form and the intensive care experience scale, which was developed by the researchers and applied through face-to-face interviews with the patients. The independent-samples t-test, Mann-Whitney U (Exact) test, one-way ANOVA (Robust Test: Brown-Forsythe), and multivariate analysis of variance were used in the analysis of the data., Results: The study included 300 patients, comprising 108 (36%) females and 192 (64%) males. No difference was found between the groups in respect of total intensive care points of emergency (57.9 ± 4.92) and elective (56.6 ± 4.58) operations (P = 0.32). The environmental awareness level and patient satisfaction of the elective group were seen to be higher, and the emergency group reported more bad experiences. Patients who had undergone emergency cardiac valve surgery were more satisfied (P < 0.001) and remembered more (P = 0.001)., Conclusion: Patients who had undergone urgent and elective cardiac surgery were seen to have had a relatively negative intensive care experience. When there was more environment awareness in patients with ICU experience, it was determined that as the duration of stay in the ICU lengthens out, the pessimistic experiences increased and ICU satisfaction decreases.

Purpose: The purpose of this study was to determine the intensive care unit (ICU) experiences of cardiovascular surgery (CS) patients and to define the associations between their ICU experiences and related factors., Methods: The study used a descriptive design. In total, 106 CS patients were interviewed at least 24 hours after discharge from an ICU in an educational research hospital in Ankara, Turkey between January and July 2012. Data were collected using the Intensive Care Experience Scale (ICES), a sociodemographic and clinical characteristics data form and two open-ended questions inquiring about smells and light. Statistical analyses were conducted using SPSS 15.0., Results: The patients were moderately aware of their ICU environments, partly recalled their ICU experiences, highly recollected frightening experiences, and expressed good satisfaction with care. Age, education, marital status, and pain were associated with ICU experiences. Patients who sensed smell had higher scores of frightening experiences than those who did not. Patients who were annoyed with excessive light reported less satisfaction with care than those who were not., Conclusions: The results suggest that measuring the patients' characteristics and environmental factors may be beneficial for healthcare teams to improve the recovery of CS patients in the ICU., (Copyright © 2015. Published by Elsevier B.V.)

We compared standard and patient-targeted in-patient education in terms of their effect on patients' anxiety. One hundred and ninety-eight patients who were hospitalised for coronary artery bypass surgery were given standard education (group 1) or individualised education (group 2) on the management of their healthcare after discharge. Patients in group 2 were assessed on the patient learning needs scale and were given education according to their individual needs. The level of anxiety was measured by the state-trait anxiety inventory. Anxiety scores were significantly lower in group 2 than group 1 after education (p < 0.001). While state anxiety did not change after education in group 1 (p = 0272), it decreased significantly in group 2 (p < 0.001). For cardiovascular surgery patients, patient-targeted in-patient education was more effective than standard education in decreasing anxiety levels, therefore the content of the education should be individualised according to the patient's particular needs.

Objective: We investigated the physical safety of cognitive-behavioral therapy (CBT) utilizing imaginal exposure in patients who suffered from posttraumatic stress disorder (PTSD) following a life-threatening cardiovascular event., Method: In this phase I, prospective, single-blind trial conducted from April 2006 through April 2008, we randomly assigned 60 patients to receive either 3 to 5 sessions of imaginal exposure therapy (experimental group) or 1 to 3 educational sessions only (control group). Criteria for PTSD and other mental health disorders were evaluated according to DSM-IV using the full Structured Clinical Interview for DSM-IV (SCID). Safety assessments included patients' blood pressure and pulse before and after each study session and the occurrence of deaths, hospitalizations, repeat myocardial infarctions, or invasive procedures. We also investigated the effects of the treatment on PTSD symptoms (Impact of Event Scale and Posttraumatic Stress Disorder Scale), depression (Beck Depression Inventory-II), and the Clinical Global Impressions-Severity of Illness (CGI-S) scale., Results: There were no significant differences between the experimental and control groups and between exposure and nonexposure sessions in any of the safety measures. In addition, confidence intervals were such that the nonsignificant effects of exposure therapy were not of clinical concern. For example, the mean difference in systolic pressure between control and exposure sessions was 0.5 mm Hg (95% CI, -6.1 to 7.1 mm Hg). Nonsignificant improvements were found on all psychiatric measures in the experimental group, with a significant improvement in CGI-S in the entire cohort (mean score difference, -0.6; 95% CI, -1.1 to -0.1; P = .02) and a significant improvement in PTSD symptoms in a subgroup of patients with acute unscheduled cardiovascular events and high baseline PTSD symptoms (mean score difference, -1.2; 95% CI, -2.0 to -0.3; P = .01)., Conclusions: Cognitive-behavioral therapy that includes imaginal exposure is safe and promising for the treatment of posttraumatic stress in patients with cardiovascular illnesses who are traumatized by their illness., Trial Registration: clinicaltrials.gov Identifier: NCT00364910., (© Copyright 2011 Physicians Postgraduate Press, Inc.)

Purpose: Owing to advances in cardiovascular surgery, patients with cardiovascular disease require improvement of health-related quality of life (QOL) than before. We measured the QOL of patients undergoing cardiovascular surgery using the eight-item Short Form (SF-8) and assessed its usefulness., Methods: This was a prospective repeated-measures observational study. The SF-8 questionnaire was completed through interviews with 117 consecutive adult patients undergoing cardiovascular surgery at a single center (Nagara Medical Center, Japan) from April 2006 to March 2008. The SF-8 was evaluated before surgery and at 7 days, 1 month, and 6 months after surgery. The physical and mental scores over time were assessed., Results: Regarding physical status, compared with the normal population, the patients' scores were worse preoperatively and had deteriorated 7 days postoperatively; they gradually got closer to preoperative status a month after the procedure. At 6 months after surgery, all physical scores were higher than before surgery. The mental scores, including a mental component summary score, were inferior to those of the normal population until 1 month postoperatively, and they reached those of the normal population at 6 months., Conclusion: The SF-8 changed with the postoperative time course. It was a useful tool for analyzing the physical and mental QOL of patients who underwent cardiovascular surgery.

Objective: This pilot study examined the discriminant validity and criterion validity of regional cerebral oxygenation measurement (rSO₂), using the near-infrared spectroscopy (NIRS) technique (INVOS-4100 system, Somanetics, Troy, MI) for measuring pain during nociceptive procedures in adults undergoing cardiac surgery., Methods: A repeated-measures, within-subjects design was used, and 40 adult patients participated. Data collection was completed during 2 test periods: (1) while patients were awake, before the induction of anesthesia (first test period); and (2) after the induction of anesthesia, while patients remained under the effects of anesthesia (second test period). Each test period included a baseline, a tactile stimulus (skin disinfection), nociceptive stimuli (e.g., intravenous and arterial line insertions, sternal bone incision and thorax opening), and a postprocedure evaluation., Results: Increased rSO₂ values (P < .001) were acquired during nociceptive procedures in both test periods. No significant associations were evident between rSO₂, pain behaviors, and the patient's self-report of pain intensity, but this may be attributable to a low range of variability., Conclusions: Although further research is needed in critically ill adult patients undergoing more painful procedures, the NIRS may become a promising technique for assessing pain., (Copyright © 2010 Elsevier Inc. All rights reserved.)

The paper analyzes the efficiency of the authors' procedure for anesthetic maintenance based on a combination of inhalational (sevoflurane) and intravenous (1% propofol) anesthesia on spontaneous breathing through a ProSeal laryngeal mask airway in the X-ray endovascular correction of congenital heart diseases in infants and young children. The study included 118 children aged 2 to 7 years with secondary atrial septal defect, who had undergone endovascular defect correction, by applying an Amplazer septal occluder. The key points of the anesthetic maintenance proposed by the authors are: (1) substitution of routine pharmacological premedication for psychological (the presence of parents); (2) inhalational (sevoflurane) anesthesia in the induction of anesthesia; (3) replacement of an endotracheal tube by a ProSeal laryngeal mask; (4) refusal of myorelaxants and respiratory support without artificial ventilation. The authors' anesthesia protocol during these operations provides a safe perioperative period.

Objectives: (1) To assess the efficacy of a 20 minute massage therapy session on pain, anxiety, and tension in patients before an invasive cardiovascular procedure. (2) To assess overall patient satisfaction with the massage therapy. (3) To evaluate the feasibility of integrating massage therapy into preprocedural practices. Experimental pretest-posttest design using random assignment. Medical cardiology progressive care units at a Midwestern Academic Medical Center. Patients (N=130) undergoing invasive cardiovascular procedures. The intervention group received 20 minutes of hands on massage at least 30 minutes before an invasive cardiovascular procedure. Control group patients received standard preprocedural care. Visual analogue scales were used to collect verbal numeric responses measuring pain, anxiety, and tension pre- and postprocedure. The differences between pre- and postprocedure scores were compared between the massage and standard therapy groups using the Mann-Whitney Wilcoxon's test. Scores for pain, anxiety, and tension scores were identified along with an increase in satisfaction for patients who received a 20-minute massage before procedure compared with those receiving standard care. This pilot study showed that massage can be incorporated into medical cardiovascular units' preprocedural practice and adds validity to prior massage studies.

Background: In patients with diabetes, comorbid depression has been shown to be associated with increased medical symptom burden, additional functional impairment, poor self-care, increased risk of macrovascular and microvascular complications, higher medical costs, and greater mortality., Objective: The authors performed a longitudinal observation to assess the pathway between diabetes complications and subsequent depression., Method: In a prospective study of primary-care patients with diabetes (N=2,759), the authors determined, from automated data and chart review, whether macrovascular or microvascular events or coronary, cerebrovascular, or peripheral vascular procedures during follow-up were associated with meeting criteria for major depression at 5-year follow-up., Results: After controlling for baseline severity of depression symptoms and history of depression, having one-or-more coronary procedures during follow-up, and baseline severity of diabetes symptoms were strong predictors of having major depression at 5-year follow-up., Conclusion: The risk of major depression among persons with diabetes is increased by previous depression history, baseline diabetes symptoms, and having had cardiovascular procedures.

Objective: The purpose of this study was to examine the dimensionality, stability, and course of depressive symptoms over the 12-month period beginning approximately 1 week before heart surgery., Methods: The Center for Epidemiological Studies Depression Scale (CES-D) was administered to 570 patients before heart surgery and 1, 3.5, 6.5, and 12.5 months later., Results: Confirmatory factor analysis rejected a four-factor model as a result of small variances for two interpersonal items. With their elimination, a three-factor solution (negative affect, low positive affect, somatic/vegetative symptoms) showed good psychometric properties. Except for the somatic/vegetative factor at the 1-month follow up, there was a high degree of stability in the factor pattern over a 12-month period beginning approximately 1 week before heart surgery. Latent mean structure analysis indicated that, apart from elevations in several somatic/vegetative symptoms during the month after surgery, means for all three depressive symptoms declined over time. The recovery of positive affect showed a steeper trajectory toward the end of the follow-up period by comparison with the rates of decline for depressed affect and somatic/vegetative symptoms., Conclusions: These findings support using 18 CES-D items to measure three depressive symptom dimensions in heart patients and may reflect a normative pattern of adjustment to heart surgery.

The complex relationships between faith factors and health locus of control were explored. Different from general expectancy, internal control was conceptualized as event-specific self-efficacy. Both control and faith are multidimensional phenomena and affect an individual's health and wellbeing. Yet, how faith and secular factors (e.g., demographic variables) are jointly related to personal control of patients in the face of medical crises remains empirically under-examined. Based on a comprehensive review of different aspects of perceived personal control, spiritual surrender, and faith factors, we presumed a multivariate association among them. Using data from two sequential interviews and the Society of Thoracic Surgeons' Adult Cardiac Database, the study examined the association between these faith factors and different health loci of control among 224 middle-aged and older patients 1 day prior to major cardiac surgery. Primary findings from multiple regression analyses generally supported our hypotheses. Greater internal control was positively related to using private prayer for coping, an event-specific "vicarious" control strategy, but negatively related to subjective religiosity, a general faith measure, after controlling for effects of other secular factors, especially cardiac-significant ones. Several factors in the medical history affected different loci of control. Older age and minority status were associated with greater external control.

Background: We sought to assess quality of life of children with transposition of the great arteries (TGA) enrolled during transition in management strategy from atrial to arterial switch operation., Methods and Results: Neonates enrolled by the Congenital Heart Surgeons Society in a prospective study of TGA between 1985 and 1989 were eligible. A Child Health Questionnaire was sent for completion by the child between February and June 2000. Data were compared with published normative values. Child Health Questionnaires were completed by 306 of 708 survivors at a mean age of 13+/-1 years. Diagnosis included TGA (n=202, 66%), TGA/ventricular septal defect (VSD) (n=84, 27%), and TGA/VSD/pulmonary stenosis (n=20, 7%). Repair type was arterial switch (n=189, 62%), atrial switch (n=105, 34%; Senning=58, Mustard=47), or Rastelli (n=12, 4%). Children with TGA scored significantly higher than published norms in all categories except self-esteem. TGA/VSD/pulmonary stenosis was associated with lower scores than TGA and TGA/VSD in physical functioning (P=0.002), general health perceptions (P=0.012), and mental health (P=0.048). Arterial repair was associated with higher scores than atrial or Rastelli repair in physical functioning (P<0.001), pain (P=0.004), mental health (P=0.019), self-esteem (P=0.004), and general health perceptions (P<0.001). By multivariable analyses, the most common independent factors impacting scores were repair type, perfusion parameters, and gender., Conclusions: Quality of life and health status as perceived by children 11 to 15 years after TGA repair is excellent when compared with published normative data and is better after arterial switch operation than after atrial repair.

The early and mid-term survival after cardiac or thoracic aortic surgery and influence of age to the operative mortality were examined in 168 consecutive patients aged 70 years and older from August 1994 to December 1998, together with assessment of postoperative quality of life (QOL). The mean age was 74.1 +/- 3.7 years old (70 to 86 years). 80 patients had IHD, 59 had VHD, 28 had TAA. Preoperative risk score was classified in 5 groups (good, fair, poor, high, extremely high) based on Parsonnet method. Current QOL of the survivors was assessed using Asanoi method with questionnaire by a letter. There were 9 early deaths (5.4%). Following the Parsonnet model observed mortality was absolutely lower than predicted mortality. When age score was excluded in the Parsonnet model, the observed mortality became almost equal with the predicted mortality. There were 22 late deaths (6.9%/P-Y). The actuarial survival rate of age 70 to 74 group was significantly higher than the age 75 years and older group (p = 0.0021). The actuarial survival rate of TAA group was significantly lower than the VHD or IHD group (p < 0.02). Postoperative NYHA and activity score of TAA group were better than VHD or IHD group. We got satisfactory answers for operation in 95% current survivors. Patients aged 70 years and older will be undergone cardiac or thoracic aortic surgery at a reasonable risk and well satisfaction.

If the physiologic symptoms of anxiety occur during a critical procedure, the length and difficulty of the procedure may be increased, inaccurate data may be obtained from the procedure, and physical harm may occur as a result. To avoid these negative outcomes, it would be beneficial to reduce the amount of anxiety felt by patients undergoing invasive procedures by psychologically preparing them for the procedure. Fourteen studies were found that examined the effects of different types of preparational treatment on the anxiety levels of patients undergoing procedures in the hospital. Overall, the research studied strongly supports the notion that preprocedural intervention reduces the amount of anxiety felt by the patients. The question remains as to what type of preprocedural preparation works best to reduce anxiety. Because this research applies to any procedure performed in a hospital, it is appropriate to extend the implications to include peripheral angiography. It is essential for vascular nurses to implement some type of psychologic preparation for their patients undergoing vascular procedures to improve their outcome and quality of life after the procedure.

Background: Negative emotional reactions and difficulty in communicating are common in patients receiving mechanical ventilation and may adversely affect recovery from cardiac surgery., Objective: To determine the effect of providing concrete objective information about emotional stress and difficulty in communicating related to mechanical ventilation to Korean cardiac surgery patients., Methods: A quasi-experimental 2-group design was used. The 22 subjects in the control group received the usual information; the 21 in the experimental group received concrete objective information in addition to the usual information. State anxiety, negative affect, use of sedative and analgesic medications, and difficulty communicating were compared between the 2 groups after surgery., Results: Patients who received concrete objective information experienced less anxiety and negative mood during mechanical ventilation, less difficulty in communicating, and a shorter intubation time than did patients in the control group. The 2 groups did not differ in the amount of sedative or analgesic medication used per hour during mechanical ventilation., Conclusions: Nursing interventions that include concrete objective information help cardiac patients cope with the stresses associated with surgery and mechanical ventilation.

Aims: The aim of the present study was to assess the occurrence of a wide range of behavioural and emotional problems long-term (> 9 years) after surgical correction for congenital heart disease in infancy and childhood., Methods: The problem scores on the Young Adult Self-Report of 166 19-25-year-old adults with congenital heart disease were compared with those of subjects of similar age from the general population., Results: On most Young Adult Self-Report scales no differences were found between the mean problem scores of the congenital heart disease-adults and reference peers. On only two Young Adult Self-Report scales (i.e. Somatic Complaints and Strange) and the total problem score were significant though small differences found between the mean problem scores of the congenital heart disease adults and reference peers. No significant relationship was found between cardiac diagnosis and problem behaviours in congenital heart disease adults. No relationship was found between IQ scores and problem behaviours in congenital heart disease adults., Conclusion: Overall, it can be concluded that the results of the congenital heart disease adults were not unfavourable, since the differences in mean (total) problem scores between the congenital heart disease sample and reference group were small and limited to only two specific problem areas.