PurposeThe Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a comprehensive screening tool for psychosocial risk assessment of transplant candidates. Its application in heart transplant (HTx) has not been reported. Our objectives were to evaluate SIPAT's inter-rater reliability (IRR) and predictive ability for 1-year outcomes in HTx patients.MethodsThis is a retrospective single center study of consecutive HTx patients transplanted from 1/1/10-6/30/11. Clinical outcomes were: 1-year survival, # of rejection episodes, and # of hospitalizations for infection/rejection. Psychosocial outcomes were: medication/clinical appointment adherence, psychosocial support system stability, substance abuse recidivism, and development/relapse of psychiatric problems. Four examiners obtained outcome data from medical charts and interviews with the post-HTx team. Three examiners, blinded to the patient outcomes, applied SIPAT retrospectively by chart review. IRR was assessed in 21 randomly selected cases. Pearson's correlation coefficients were used to assess IRR and explore bivariate relationships of outcomes with demographics and SIPAT scores. Multivariate logistic regression analysis of outcomes included variables significant at p<0.05.ResultsWe studied 51 adults (31% female, age=48 ± 14.2 years). SIPAT showed excellent IRR (Table). In logistic regression models, SIPAT scores predicted nonadherence with clinic appointments (p=0.01) and medications (p=0.05), but not 1-year survival, rejection/infection episodes, or hospitalizations. SIPAT's Lifestyle and Substance Use subscale predicted development/relapse of psychiatric problems (p=.04).Conclusion PurposeThe Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a comprehensive screening tool for psychosocial risk assessment of transplant candidates. Its application in heart transplant (HTx) has not been reported. Our objectives were to evaluate SIPAT's inter-rater reliability (IRR) and predictive ability for 1-year outcomes in HTx patients. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a comprehensive screening tool for psychosocial risk assessment of transplant candidates. Its application in heart transplant (HTx) has not been reported. Our objectives were to evaluate SIPAT's inter-rater reliability (IRR) and predictive ability for 1-year outcomes in HTx patients. MethodsThis is a retrospective single center study of consecutive HTx patients transplanted from 1/1/10-6/30/11. Clinical outcomes were: 1-year survival, # of rejection episodes, and # of hospitalizations for infection/rejection. Psychosocial outcomes were: medication/clinical appointment adherence, psychosocial support system stability, substance abuse recidivism, and development/relapse of psychiatric problems. Four examiners obtained outcome data from medical charts and interviews with the post-HTx team. Three examiners, blinded to the patient outcomes, applied SIPAT retrospectively by chart review. IRR was assessed in 21 randomly selected cases. Pearson's correlation coefficients were used to assess IRR and explore bivariate relationships of outcomes with demographics and SIPAT scores. Multivariate logistic regression analysis of outcomes included variables significant at p<0.05. This is a retrospective single center study of consecutive HTx patients transplanted from 1/1/10-6/30/11. Clinical outcomes were: 1-year survival, # of rejection episodes, and # of hospitalizations for infection/rejection. Psychosocial outcomes were: medication/clinical appointment adherence, psychosocial support system stability, substance abuse recidivism, and development/relapse of psychiatric problems. Four examiners obtained outcome data from medical charts and interviews with the post-HTx team. Three examiners, blinded to the patient outcomes, applied SIPAT retrospectively by chart review. IRR was assessed in 21 randomly selected cases. Pearson's correlation coefficients were used to assess IRR and explore bivariate relationships of outcomes with demographics and SIPAT scores. Multivariate logistic regression analysis of outcomes included variables significant at p<0.05. ResultsWe studied 51 adults (31% female, age=48 ± 14.2 years). SIPAT showed excellent IRR (Table). In logistic regression models, SIPAT scores predicted nonadherence with clinic appointments (p=0.01) and medications (p=0.05), but not 1-year survival, rejection/infection episodes, or hospitalizations. SIPAT's Lifestyle and Substance Use subscale predicted development/relapse of psychiatric problems (p=.04). We studied 51 adults (31% female, age=48 ± 14.2 years). SIPAT showed excellent IRR (Table). In logistic regression models, SIPAT scores predicted nonadherence with clinic appointments (p=0.01) and medications (p=0.05), but not 1-year survival, rejection/infection episodes, or hospitalizations. SIPAT's Lifestyle and Substance Use subscale predicted development/relapse of psychiatric problems (p=.04). Conclusion

Cjrculatjoo CORE 2. EPIDEMIOLOGY AND PREVENTION OF CV DISEASE: PHYSIOLOGY, PHARMACOLOGY AND LIFESTYLE SESSION TITLE: FATIGUE AND CARDIAC PATIENTS: SICK AND TIRED Abstract 14574: Who is at Risk for Exhaustion Post-Cardiac Surgery Pamela S Miiier, Lorraine S Evangellsta, Joyce Newman Giger, Teresita Corvera-Tinclel, Otonlel Martinez-Maza, Kathleen Dracup and Lynn V Doering Published: November 22, 2011 Artlcle Info & Metrics •Letters ... Jumpto Abstract Background: Vital exhaustion (VE), a psychological state characterized by extreme fatigue, is an independent prognostic indicator of future cardiac events. Despite its prognostic value, little is known about predictors of VE after cardiac surgery. Objective: To investigate socio-demographic and clinical factors associated with risk of postoperative VE following coronary artery bypass graft (CABG) surgery. Methods: In a prospective, cross-sectional pilot study at two cardiac centers, 42 post-CABG patients (age 67.5 ± 12.6 years, 90.5% male) were screened for depression (Patient Health Questionnaire-2) and evaluated for VE (Maastricht Interview) 4 to 8 weeks post-hospitalization discharge. Potential covariates included socio- demographics, clinical characteristics, medical history, cardiovascular risk factors, medications, and preoperative hematology. Stepwise logistic regression analyses were performed to identify predictors of VE. Results: Prevalence rate of VE was approximately 41% (n = 17). Older patients(> 65 years) were less likely to be exhausted (Table; p < 0.05). After adjusting for age, independent predictors of exhaustion were presence of right coronary artery disease (p < 0.05) and higher preoperative left ventricular ejection fraction (LVEF: p < 0.01 ). In a

Unlike drug abuse or incarceration, homelessness is not a Centers for Disease Control criterion for high risk organ donation. The purpose of this study was to explore the impact of donor homelessness on recipient outcomes after heart transplant (HTX).

Author(s): Goebel, JR; Doering, LV; Shugarman, LR; Asch, SM; Sherbourne, CD; Lanto, AB; Evangelista, LS; Nyamath, AM; Maliski, SL; Lorenz, KA

BACKGROUND:The literature supports nursing interventions to maximize communication in mechanically ventilated patients, yet limited research exists on patients' perceptions of the helpfulness of health care practitioner interventions to enhance communication. In addition, the level of frustration experienced by these patients has not been reported. Thus, further research is necessary to examine patients' perspectives of the helpfulness of health care practitioner interventions that enhance communication of the mechanically ventilated patient.OBJECTIVES:This study describes the level of frustration experienced by mechanically ventilated patients and ascertains the helpfulness of methods used by health care practitioners to meet the communication needs of the mechanically ventilated patient.METHODS:A total of 29 critically ill patients, extubated within the last 72 hours, were included in this descriptive study using qualitative and quantitative methods. Subjects participated in an average 30-minute audiotaped interview session consisting of questions pertinent to their perceived level of frustration in communicating and the interventions practitioners used to meet their communication needs. Transcripts were analyzed by question and for overall themes.RESULTS:It was found that 62% of patients (n = 18) reported a high level of frustration in communicating their needs while being mechanically ventilated. There was no significant difference between the duration of intubation and the level of frustration (Spearman r =.109, P =.573) or between the diagnosis and the level of frustration (P =.932). Patients who received anxiolytics (n = 23, 79% of the sample) had a lower level of frustration (mean 3.26) than those who did not receive anxiolytics (n = 6, 21% of the sample, mean 4.33). This difference trended toward significance (P =.084). Patients cited health care practitioner behaviors, characteristics, and attributes that both facilitated communication (kind, informative, and physically present at the bedside) and impeded their ability to communicate (mechanical, inattentive, and "absent" from the bedside). Patients reported problems and stresses associated with communication difficulties that can be alleviated by the health care practitioner.CONCLUSIONS:Mechanically ventilated patients experience a high level of frustration when communicating their needs, and health care providers have a significant impact on the mechanically ventilated patient's experience. Further research is needed to explore and measure methods of facilitating communication that increase patient satisfaction, reduce patient anxiety, and obtain optimal pain management.

Background: Patients having cardiac symptoms often delay for hours before seeking treatment. Delay time is usually defined as the amount of time between the patient’s first awareness of symptoms and arrival at the hospital. Excessive delays in seeking medical care for heart failure (HF) symptoms may influence patient outcomes. However, the treatment-seeking patterns of HF patients are not well understood. Methods: We obtained data through a retrospective chart audit to describe the treatment-seeking behaviors of 753 HF patients, at a Veterans Administration facility, and to identify predictors of delay in seeking medical care for HF symptoms. Using univariate and multivariate analyses, we assessed relationships among delay time, presenting symptoms, and patient characteristics. Results: The mean delay time was 2.93 6 0.68 days. The most common symptoms on admission were dyspnea (76%), edema (66%), fatigue (37%), and angina (25%). Variables negatively affecting delay time included presence of dyspnea and edema (odds ratio [OR], 2.10 and 1.82; confidence interval [CI], 1.38 to 3.19 and 1.17 to 2.82, respectively), care by a primary care physician (OR, 2.04; CI, 1.45 to 2.88), and higher New York Heart Association (NYHA) Class (OR, 1.96; CI, 1.47 to 2.61). Variables positively affecting delay time were the presence of chest pain (OR, 0.42; CI, 0.29 to 0.62) and a history of previous admission for HF (OR, 0.42; CI, 0.28 to 0.62). Conclusions: Delays in seeking treatment for HF symptoms are significantly high. This study supports the need for interventions that will increase early symptom recognition and management on the part of patients and their families. J Heart Lung Transplant 2000;19:932–938.

OBJECTIVES:To evaluate the usefulness of transthoracic electrical bioimpedance in trending changes in cardiac output after cardiac surgery, and to identify predictors of differences between cardiac output measured by thermodilution and transthoracic electrical bioimpedance methods.DESIGN:Prospective repeated-measures study.SETTING:University-affiliated tertiary care center.PATIENTS:Thirty-four adult patients undergoing elective cardiac surgery with routine pulmonary artery catheter placement.INTERVENTIONS:Simultaneous paired cardiac output measurements by transthoracic electrical bioimpedance and thermodilution were made at four time points: within 2 hrs of intensive care unit (ICU) admission; when the patient reached a normothermic temperature; after extubation; and 24 hrs after ICU admission.MEASUREMENTS AND MAIN RESULTS:Mean measurements by each method over time did not differ, except at ICU admission, when compared by repeated-measures analysis of variance. For each time point, bias and precision between methods were calculated. Bias calculations ranged from 0.02 to 0.21 L/min/m2. Precision calculations ranged from 1.06 to 1.52 L/min/m2. Predictors of between-method differences identified by a multiple regression model of hemodynamic variables were: increased systemic vascular resistance index, decreased mean arterial pressure (MAP), and the presence of atrial or ventricular pacing.CONCLUSIONS:While mean postoperative cardiac output measurements did not differ by method over time, agreement between transthoracic electrical bioimpedance and thermodilution methods was poor in the immediate postoperative period, with precision calculations indicative of clinically significant differences. Increased systemic vascular resistance index and decreased MAP were predictive of larger between-method differences.

This article explores the concepts of power and knowledge from two philosophical perspectives, the feminist and the poststructuralist, and examines their application to nursing knowledge and nursing science. Principles of poststructuralist and feminist philosophies are presented. The role of the nursing-medicine power relation in the development of nursing knowledge and the interaction of gender issues in that relation are reviewed in the context of nursing history. Both past and current mechanisms that contribute to the maintenance of the nursingmedicine power relation are discussed.

Recruitment and retention of critical care nurses is a major concern for nurse managers. Factors that affect recruitment and retention are management style, perceptions of isolation, stress, and burnout. Decentralization, primary nursing, and clinical advancement programs are strategies that allow nurses to participate in decision making at the unit level and to be recognized for their individual contributions. The application of these strategies to a cardiac surgery intensive care unit is presented.

Cardiac output was measured by thermodilution in 51 adult postcardiac surgical patients using three positions, supine, right lateral, and left lateral, each with 20° backrest elevation. Measurements were taken 4 to 24 hours (M = 10.58) after surgery. Mean cardiac output was significantly different in the three positions, p = .03. This difference resulted from changes in stroke volume, p = .004, rather than changes in heart rate, p = .12. The largest variation occurred between cardiac outputs measured in the supine position and those measured in the left lateral position. Patients at greatest risk for variations in cardiac output with lateral postural change were those with a cardiac index less than 2.3 L/min/m2, those in whom the time elapsed since surgery was less than 12 hours, and those receiving either vasoactive drugs or mechanical ventilation. These results suggest that nurses need to measure cardiac output using a supine position to control for physiological changes that may occur with lateral postural change.