ABSTRACT
BACKGROUND: Several studies have looked at the effects on mood and quality of life (QOL) among patients who underwent on-pump coronary artery bypass grafting (CABG), but few have reported on off-pump CABG (OPCABG). METHODS: We recruited 50 patients undergoing OPCABG. The day before CABG, patients were interviewed using 4 questionnaires: the Beck Depression Index (BDI), Beck Anxiety Index (BAI), Sheehan Disability Scale (SDS), and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). The process was repeated at 1, 3, 6, and 9 months. RESULTS: One month postoperatively, patients showed increased levels of depression (Δ 1.67 in the mean BDI score, P < .05) and disability (Δ 5.28 in the mean SDS score, P < .001) and decreases levels of anxiety (Δ 3.7 in the mean BAI score, P < .001) and QOL compared with baseline. When compared with the first month, at 9 months patients were significantly less depressed (Δ 3.58 in the mean BDI score, P < .001), were less disabled (Δ 5.34 in the mean SDS score, P < .001), and had better QOL (Δ 3.82 in the mean Q-LES-Q score, P = .014). At 9 months, 44% had some degree of depression and 48% had low QOL. CONCLUSION: Despite that all scores returned to or below baseline at 9 months, a high percentage of patients still had depressive symptoms and overall poor quality of life (QOL). BDI scores at baseline are good predictors of QOL at all measured intervals. This should make physicians more prudent in diagnosing and observing these patients.
Subject(s)
Coronary Artery Bypass, Off-Pump/psychology , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Disability Evaluation , Quality of Life/psychology , Adaptation, Psychological , Aged , Anxiety Disorders/diagnosis , Anxiety Disorders/psychology , Comorbidity , Female , Follow-Up Studies , Humans , Male , Middle Aged , Personality Inventory/statistics & numerical data , Prospective Studies , PsychometricsABSTRACT
OBJECTIVES: Methicillin-resistant Staphylococcus aureus is a common cause of ventilator-associated pneumonia and can be identified by the mecA gene that confers resistance. The objective was to develop a polymerase chain reaction assay for mecA using mini-bronchoalveolar lavage to allow rapid diagnosis of ventilator associated pneumonia attributable to methicillin-resistant Staphylococcus aureus. DESIGN: Real-time quantitative polymerase chain reaction was developed using serial dilution of plasmids containing known amounts of mecA gene fragments. Specificity of molecular identification was based on the presence of the mecA gene and S. aureus-specific femA-SA gene, with absence of Staphylococcus epidermidis specific femA-SE. SETTING AND PATIENTS: To validate the polymerase chain reaction, we compared it to mini-bronchoalveolar lavage quantitative cultures in 100 mechanically ventilated patients with suspected pneumonia. We derived a threshold value for defining a positive polymerase chain reaction based on a priori criteria of 100% sensitivity. We then tested the polymerase chain reaction using this threshold value on a separate cohort of 50 patients. MAIN RESULTS: Polymerase chain reaction was able to detect mecA down to a copy number of three, with a high degree of correlation (r=.999). The area under the receiver-operating characteristic curve for polymerase chain reaction was 0.98 (95% confidence interval, 0.93-0.99). Using a cut-point of >or=421 for the polymerase chain reaction resulted in sensitivity of 100%, specificity of 87% (95% confidence interval 81%-94%), positive predictive value of 39% (95% confidence interval, 29%-49%), negative predictive value of 100%, and an overall correct classification rate of 89%. Applying the polymerase chain reaction with a cut-point of >or=421 to the second cohort resulted in a sensitivity of 100% and a specificity of 80%. CONCLUSIONS: Quantitative polymerase chain reaction of mecA combined with femA-SA and femA-SE detection was able to rapidly and accurately diagnose methicillin-resistant S. aureus.
