ABSTRACT
No disponible
Subject(s)
Humans , Male , Aged, 80 and over , Streptococcus milleri Group , Streptococcus milleri Group/isolation & purification , Streptococcus anginosus , Streptococcus anginosus/isolation & purification , Aortic Rupture/drug therapy , Aortic Rupture/rehabilitation , Aortic Rupture/surgery , Blood Vessel Prosthesis/adverse effects , Blood Vessel Prosthesis/microbiology , Endovascular Procedures/methods , Aortic Diseases/drug therapy , Aortic Diseases/surgery , Immunosuppressive Agents/therapeutic useABSTRACT
PURPOSE: The author, a rehabilitation specialist of more than 30 years, presents her observations of the medical and rehabilitation services her husband received after a ruptured abdominal aortic aneurysm. Building on the person-centred approach, she identified several problems and describes theory-based strategies how she and her husband (patient) addressed these problems. In addition, she provides insight in the complex role she fulfilled as family caregiver: liaison, advocate and as personal health manager (taking care of her own health). METHOD: A qualitative analysis and interpretation based on personal observations and discussions with medical and rehabilitation professionals. RESULTS: The author argues that the culture of the institution (knowledge and compassion) and the role of the patient advocate have major implications on the outcome of a patient's functional gains. The International Classification of Functioning, Disability and Health can be a useful tool to enhance transparency within the patient-centred approach. CONCLUSION: Although this case study is described from the perspective of one case, the information shared in this paper may stimulate further discussion and research in the concept and implementation of person-centred rehabilitation.
Subject(s)
Aortic Aneurysm, Abdominal/rehabilitation , Aortic Rupture/rehabilitation , Patient Preference , Patient-Centered Care , Aged, 80 and over , Caregivers , Humans , MaleABSTRACT
OBJECTIVES: Endovascular repair of the descending thoracic aorta is a very promising technique in elective and, particularly, emergency situations. This study assessed the impact of urgency of the procedure on outcome and mid-term quality of life in surviving patients. METHODS: Post hoc analysis of prospectively collected data of 58 consecutive patients (January 2001-December 2005) with surgical pathologies of the descending thoracic aorta treated by endovascular means. Six patients were excluded due to recent operations on the ascending aorta before thoracic endovascular repair. The remaining patients (n=52) were 69+/-10 years old, and 43 were men (83%). Twenty-seven had been treated electively, and 25 for emergency indications. Reasons for emergency were acute type B aortic dissections with or without malperfusion syndrome in 14, and aortic ruptures in 11 cases. Follow-up was 29+/-16 months. Endpoints were perioperative and late morbidity and mortality rates and long-term quality of life as assessed by the short form health survey (SF-36) and Hospital Anxiety and Depression Scale questionnaires. RESULTS: Cohorts were comparable regarding age, sex, cardiovascular risk factors, and comorbidities. Perioperative mortality was somewhat higher in emergency cases (12% vs 4%, p=0.34). Paraplegia occurred in one patient in each cohort (4%). Overall quality of life after two and a half years was similar in both treatment cohorts: 72 (58-124) after emergency, and 85 (61-105) after elective endovascular aortic repair (p=0.98). Normal scores range from 85 to 115. Anxiety and depression scores were in the normal range and comparable. CONCLUSIONS: Thoracic endovascular aortic repair is an excellent and safe treatment option for the diseased descending aorta, particularly in emergency situations. Early morbidity and mortality rates can be kept very low. Mid-term quality of life was not affected by the urgency of the procedure. Similarly, mid-term anxiety and depression scores were not increased after emergency situations.
Subject(s)
Aorta, Thoracic/surgery , Aortic Diseases/surgery , Blood Vessel Prosthesis Implantation/methods , Quality of Life , Aged , Aortic Dissection/rehabilitation , Aortic Dissection/surgery , Aortic Aneurysm, Thoracic/rehabilitation , Aortic Aneurysm, Thoracic/surgery , Aortic Diseases/rehabilitation , Aortic Rupture/rehabilitation , Aortic Rupture/surgery , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/rehabilitation , Emergencies , Epidemiologic Methods , Female , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
Abdominal aneurysm repair in octogenarians is controversial. To justify surgery, survival with a reasonable quality of life is required. Between 1980 and 1988, 34 octogenarians underwent aortic aneurysm surgery (14 elective, 20 emergency). Of the 21 survivors, 20 were interviewed to determine their quality of life. At the time of interview the patients had a median survival of 19 months (range 4-67 months). Twenty age/sex matched normal patients, from the same GP population, were interviewed for comparison. A structured questionnaire was used to assess: physical mobility, activities of daily living, sleep and emotional problems. A symptom survey was also performed. The survival trend of elective patients was similar to that of a demographically similar 'normal' population. The survival trend of emergency patients returned to 'normal' after the first postoperative month. Quality of life of the 20 patients was comparable to the lifestyle enjoyed by normal subjects. Of the 20 patients interviewed, 18 had returned home after surgery. Elective and emergency aortic aneurysm surgery can be performed with reasonable survival and a good quality of life, and therefore cannot be denied to octogenarians on the basis of age alone.
