Recovery patterns and lifestyle changes after coronary angioplasty: the patient's perspective.

BACKGROUND: Progression of coronary atherosclerosis remains a significant problem after percutaneous transluminal coronary angioplasty (PTCA), requiring patients to make ongoing modifications in their coronary risk factors and lifestyle. OBJECTIVE: To examine patients' reactions to suggested lifestyle changes, to identify barriers and facilitators to risk reduction, to identify sources of health information, and to elicit suggestions for nursing interventions to aid in long-term recovery. DESIGN: Qualitative study using 2-hour, tape-recorded focus group sessions. Participants were enrolled in one of seven groups (4 to 9 members each). SAMPLE: Forty-five patients (26 men, 19 women) who had undergone PTCA 3 to 18 months earlier were recruited from a university-affiliated midwestern medical center. RESULTS: Using a constant-comparative method for data analysis, six major themes emerged. Positive themes included seeking control from successful changes made; compromise with medical recommendations to maintain quality of life; and acceptance of the uncertain nature of their disease. Negative themes included powerlessness to stop disease progression; frustration with enacting lifestyle changes; and concerns about the uncertainty of the future. Specific barriers and facilitators for risk reduction were readily identified. Though patients had few suggestions for nursing interventions, the most predominant requests were for newsletters, "hot lines," and a video library. CONCLUSION: These results provide insight into the experiences of the relatively understudied PTCA population. Patients were making at least some of their necessary lifestyle changes, though often with some difficulty. Nurses have an excellent opportunity to expand their focus and provide guidance and support to patients as they adopt a heart-healthy lifestyle.

Patients' responses to the angioplasty experience: a qualitative study.

BACKGROUND: The number of coronary angioplasty procedures performed has increased more than tenfold in the past decade. Most research to date has focused on efficacy of the procedure, quality-of-life issues, and measures to promote comfort after percutaneous transluminal coronary angioplasty. Little or no research has examined the patient's experience during angioplasty. OBJECTIVE: The purpose of this study was to describe the angioplasty experience from the patient's unique perspective. METHOD: Focus-group interviews were used as the qualitative method for data collection. The sample consisted of 45 patients (26 male, 19 female) who had undergone percutaneous transluminal coronary angioplasty 3 to 18 months before the interviews. Seven focus groups (with four to nine subjects each) were conducted. Each 2-hour interview was tape recorded. Data were analyzed by using a constant comparative method. RESULTS: A wide range of themes emerged from the data. Positive themes included the following: contentment with comfort measures, satisfaction with supportive hospital care, and trust in medical competence. Negative themes included anger over unmet needs for comfort or support, feeling dehumanized, and frustration with lack of control in decision making. CONCLUSIONS: This study uncovered a broad range of experiences among patients undergoing percutaneous transluminal coronary angioplasty. Although most participants described very positive experiences, many patients expressed bitter dissatisfaction regarding several aspects of their care. Healthcare providers must be aware of these possible reactions so that they can anticipate, recognize, and intervene early and appropriately.

Care of the adult patients with cystic fibrosis.

Although no therapeutic breakthrough has taken place, the life expectancy of patients with cystic fibrosis (CF) has dramatically increased in the last 20 yrs. Nowadays, more than 80% of the patients outlive 18 yrs of age, with a mean survival age approaching 28 yrs. These favourable results are due mainly to early diagnosis and continuous treatment in specialized centres. The main therapeutic items are: prevention and early treatment of lung infections, mainly due to Pseudomonas aeruginosa, drainage of bronchial secretions (postural drainage, forced expiratory techniques, positive-expiratory-pressure mask, autogenic drainage,...), substitutive therapy with pancreatic enzymes and hypercaloric diet. Thus cystic fibrosis is increasingly a disease which involves adults, with many related problems, which span from the difficulties of prescribing an effective antibiotic therapy in cases with multiple resistances, to combining the need for a long daily physiotherapy schedule with school or a working life. Sexual problems and related psychological troubles are an important issue in the management of cystic fibrosis in adult patients, and are accordingly treated.

Old and new in chest physiotherapy.

Some "old" chest physiotherapy techniques, such as postural drainage of bronchial secretions, breathing control, relaxation, pre- and post-surgical treatments and exercise training have survived until today because of their unquestionable and persistent validity. This does not mean that in this field of rehabilitation medicine nothing new exists. Chest physiotherapy has now completely overcome the empirical phase that characterized every branch of medicine during its early development. We now employ mainly respiratory pathophysiology techniques for objective evaluation of physiotherapy efficacy. For example we use transcutaneous monitoring of blood gas variations during therapy. Among new chest physiotherapy techniques, biofeedback training may lead to better relaxation in a shorter time, and it is now widely used in breathing control. Jet-ventilation and percussion-ventilation seem likely to mark a further improvement in bronchial secretion drainage. Concerning the future of chest physiotherapy, the recent advances in the physiology and pathophysiology of respiratory muscles are disclosing important practical implications, e.g. in defining criteria for respiratory muscle training and rest in chronic respiratory failure.

[Methodological problems in the induction of exercise-induced asthma in atopic patients]. / Problemi metodologici nell'induzione di asma da sforzo in pazinti atopici.

The considerable discrepancy in results reported by the literature on the question of exercise induced asthma (EIA) poses some methodological problems as regards the standardisation fo such tests. As the variability of the response depends to a great extent on the duration of the physical effort (and, to a smaller extent, on other quality features of the exercise), the importance of being able to deploy an effective, standardised control instrument, with characteristics of simplicity and easy repeatability, is evident. An exercise test with these features is proposed here and significant results in an early sample of ten patients suffering from atopical asthma are reported.

[Functional respiratory rehabilitation in exudative pleuritis]. / La riabilitazioe funzionale respiratoria nelle pleuriti essudative

The rehabilitation of respiratory function in exudative pleurisy has two objectives, namely the prevention of adhesions, or, when this is no longer possible, to limit their influences on respiratory function. Stress is laid on the importance of the moment when rehabilitation management begins. The main moments of the treatment programme are reviewed, and an explanation is offered of the techniques adopted, and the functional tests best suited for assessment of the results. Lastly, reference is made to the satisfactory results observed in 50 patients.

[Study of the respiratory manifestations of systemic lupus erythematosus]. / Contributo clinico allo studio delle manifestazioni respiratorie del lupus erythematodes sistemico.

Following a short discussion of the anatomopathological and clinical features of respiratory signs during systemic l.e., some clinical cases in which involvement of the respiratory system (pleural and/or parenchymal) was observed alone or was clearly predominant are reported. The cases also presented some unusual clinical characteristics. Clinical investigations must be extended to the systemic mesenchyma in the presence of pleuritis or pulmonary fibrosis of unclear aetiology, even where there are no extra-respiratory signs of S.L.E.

[Endothoracic Hodgkin's disease. Description of 3 cases with predominantly endobronchial extrinsication]. / Il morbo di Hodgkin endotoracico. Descrizione di tre casi a prevalente estrinsecazione endobronchiale.

Three cases of endobronchial lymphogranuloma are reported. The clinical and histological aspects of lung localization of Hodgkin's disease are outlined. Special attention is paid to a case of concomitant broncho-oesophageal involvement of the lymphogranulomatous process and therapeutic problems are reviewed.