In this paper we describe the phenomenon of post-traumatic stress disorder (PTSD) as it is currently recognized. We examine some of the social influences that influence how the disorder is regarded. Although usually seen as something that is inflicted upon individuals from outside, we argue that the disastrous event might equally be an internal occurrence such as acute myocardial infarction (AMI). Summarizing the clinical evidence for PTSD following AMI, we note that post-traumatic stress symptoms are relatively common, but that most sufferers' problems resolve. For a significant minority, however, symptoms appear prolonged and significant, and with this latter group in mind, we argue that adjustments should be made in current rehabilitation practices to include screening for those at risk. The end point must be to facilitate effective intervention for those with chronic problems, rather than to advocate general mobilization of resources in a problem that, for many, is time limited.
There is increasing evidence for the protective effect of a diet low in total and saturated fat and high in fresh fruit and vegetables in the primary and secondary prevention of coronary heart disease (CHD). This review describes recent evidence and international nutritional/dietary guidelines that outline both the effects of dietary change on coronary risk and the implications for current advice offered in clinical practice. Given the considerable body of evidence, it is concluded that comprehensive dietary management should be central to the routine primary and secondary prevention of CHD.
Cardiovascular disease remains the commonest cause of mortality in people with diabetes. Previous attempts to reduce the burden of heart disease in people with diabetes have tended to concentrate on the reduction of conventional cardiovascular risk factors, and less attention has been paid to wider aspects of cardiovascular disease in this group of people. The Heart Outcomes Prevention Evaluation (HOPE) study was a large, randomized trial with wide entry criteria which examined the hypothesis that ACE inhibition using ramipril would reduce cardiovascular events in patients at high risk who would not previously be treated with ACE inhibitors. Diabetes was a pre-defined subgroup, and over three thousand patients with diabetes were recruited who had evidence of vascular disease, or had diabetes and one other cardiovascular risk factor (cholesterol > 5.2, hypertension, microalbuminuria, smoking). The study was discontinued prematurely because of a significant reduction in the composite primary end-point of myocardial infarction, stroke, and death from cardiovascular disease. In the diabetic patients the primary event rate of the combination of myocardial infarction, stroke and cardiovascular death was reduced by a quarter in patients on ramipril, and this reduction was seen both in patients with and without previous cardiovascular disease. The benefit was greater than could be accounted for by the minor decrease in blood pressure, suggesting wider effects on the cardiovascular system. Ramipril also reduced the development of overt nephropathy in diabetic subjects with microalbuminuria. Ramipril should be considered for diabetic patients with existing cardiovascular disease, or who have a high risk of disease because of the presence of cardiovascular risk factors. Copyright 2001 Harcourt Publishers Ltd Copyright 2001 Harcourt Publishers Ltd doi: 10.1054/chec.2001.0111, available online at http://www.idealibrary.com on
Despite proven benefits of reducing mortality and morbidity (Dusseldorp et al. 1999; Linden et al. 1996), attendance at cardiac rehabilitation (CR) is low (King & Teo 1998). The aim of this research was to explore beliefs held on recovery and CR by attenders and non-attenders; and to examine the usefulness of the Self Regulatory Model and the Theory of Planned Behaviour when interpreting the results. Semi-structured interviews were carried out with a total of 21 people, 3 months after they had been admitted to a district hospital with myocardial infarction (MI). Nine people had attended a CR programme, six people had originally accepted an offer to attend, but then did not attend, and six people who declined the offer and did not attend. The transcripts were subjected to interpretative phenomenological analysis (IPA). Several key differentiating themes were identified: use of medical versus psychological model; illness perception; control; causal attribution; coping strategies; and attitude to CR. Attenders were more likely to see themselves in control of their recovery and to view the programme as a way of taking responsibility for improving their health and reducing their chances of recurrence. Attenders were also more likely to use information seeking ways of coping whilst non-attenders used avoidance/minimizing coping strategies. The technique of IPA proved useful in allowing an abstraction of the factors affecting the decision-making process.
Coronary heart disease (CHD) risk factors are important to modify due to their association with CHD. Cardiac rehabilitation providing secondary prevention aims to reduce these CHD risk factors. This study was undertaken to explore the need for change in the management of secondary prevention in the patient admitted to hospital with angina pectoris and the patient's learning needs of the modifiable CHD risk factors. A small scale descriptive survey design was utilized using triangulation methodology with a convenience sample of 40 patients admitted with angina pectoris to a 12 bedded Coronary Care Unit (CCU) in Crosshouse Hospital, Kilmarnock. Ethical approval was granted from Ayrshire and Arran research ethics committee. A questionnaire was utilized for collecting quantitative data on the patient's modifiable CHD risk factors and a semi-structured interview schedule for collecting qualitative data on the patient's learning needs of their modifiable CHD risk factors.Results : Many patients with angina pectoris still have modifiable risk factors not yet modified just prior to discharge (n = 37; 92.5%). Many patients wish further information on how to modify these risk factors.Conclusion : There is potential to improve the modification of the CHD risk factors that patients with angina pectoris have when admitted to hospital. The patients themselves wish further information on how to modify these risk factors and cardiac rehabilitation can offer this.
The effect of SiO2-based substrates on the red luminescence of Eu(Phen)2X3 complexes (X ≡ Cl-, NO3–) is studied by means of semiempirical methods (Sparkle/AM1; INDO/S-CIS) and the simplified TDDFT method of Grimme. Structure, spectroscopic properties and energy diagrams are reproduced, and the most concurrent energy transitions are determined. Ligand-to-metal energy transfer mechanisms and the emission properties of the lanthanide ions are assessed using the Judd-Ofelt and Malta’s theories and QDC model. All theoretical estimates are validated by comparison with available experimental results. The factors that stimulate the high emission intensities and contribute to the efficiency of light conversion are discussed.
Today’s cardiac rehabilitation programmes are multiphase and interdisciplinary. The aim of the study was to compare different cardiac rehabilitation approaches available to patients with ischaemic heart disease and their next-of-kin during a 5-year period in five counties in western Sweden. Questionnaires were answered on two occasions, in 1993 and 1998, dealing with the cardiac rehabilitation organization, the target groups invited, rehabilitation efforts, and the health-care professionals involved in the cardiac rehabilitation. The results show that patients with myocardial infarction and their next-of-kin were offered a well-functioning cardiac rehabilitation, both in 1993 and in 1998, at the university, county and district county hospitals. For patients who had undergone bypass surgery and their next-of-kin, cardiac rehabilitation was only available to a lesser extent. Patients with angina pectoris and their next-of-kin had the least possibility of receiving cardiac rehabilitation during the 5-year period. No cardiac rehabilitation programmes were specially designed for women, and an age limit existed in some cases. The most developed cardiac rehabilitation effort was the stress management education. The health-care professionals most frequently included in the cardiac rehabilitation teams at the university and district county hospitals were dieticians, cardiologists, physiotherapists and nurses, both in 1993 and in 1998. The corresponding health-care professionals at the county hospitals were cardiologists, social workers, clergymen, physiotherapists and nurses. A research implication can be to identify who the next-of-kin are, what their experiences are of participating in a cardiac rehabilitation programme and how important they are to these patients.
Current public health policy emphasizes the importance of primary and secondary prevention of coronary heart disease (CHD). However, evidence on the effectiveness of health advice to modify behavioural risk factors to date is discouraging. This lends urgency to understanding more about the public’s perceptions of the causes and consequences of heart disease, and particularly any barriers to adopting less coronary prone behaviours.
This paper describes the impact of an imposed medico-legal driving ban on a group of internal cardioverter defibrillator (ICD) recipients and their partners, an area where there is little good quality research. A qualitative framework was adopted and involved using semi-structured interviews to elicit the experiences of seven patients and their partners about coping once discharged home. From the analysis of the fourteen interview transcriptions, five themes emerged which the patients and partners ascribed to the imposed driving ban. These included: feelings of resentment and anger; increased dependence on others; lacking confidence in driving; and imposed family sanctions when driving. However, relationship conflicts over driving was a key consistent theme and this was attributed to changes in driving role between patient and partner. The data would suggest that patients and partners might not fully appreciate the immediate consequences of the driving ban on their lifestyle and find the period of waiting before the ICD recipient is authorised to drive again difficult. Additionally, the experiences of the participants suggest that being banned from driving may be interwoven with aspects relating to altered self-image, loss of independence and social isolation. The importance of clinical staff providing co-ordinated support and adequately preparing patients and their partners for discharge is discussed in detail. Ethical considerations and implications for the future are also addressed.
