Patient-surrogate agreement of predictors of decision delay among patients with acute myocardial infarction: a questionnaire survey.

BACKGROUND: Studies that assessed predictors of patient delay to seek healthcare for acute myocardial infarction lack generalization to all patient population as it investigated patients who survived coronary events. OBJECTIVES: To evaluate utility of using surrogates to proxy patients who cannot be interviewed and to examine patients-surrogate agreement. DESIGN: A cross-sectional descriptive survey study. The cognitive and emotional domains of the modified Response to Symptoms Questionnaire were used to interview participants. PARTICIPANTS AND SETTINGS: A convenient sample of patient-surrogate pairs was collected (n=109). Hospitalized patients with acute myocardial infarction were eligible if they were at least 18 years old, hemodynamically stable, pain free or controlled pain during interview, and could identify a surrogate. Exclusions (n=45) were patients transferred from other hospitals or those who had acquired heart attack following their admission. A surrogate was defined as an individual who witnessed the onset of symptoms and whom the patient has articulated symptoms with prior to admission. METHODS: Patient and surrogate were interviewed independently. Decision delay time was assessed by assisting participants and surrogates to triangulate the time of symptom onset and time of decision to seek help by placing it in the context of events that they would remember. The intraclass correlation coefficient was used to assess agreement. RESULTS: Patients were mainly men (81%), married (79%) and ranged in age from 39 to 78 years while surrogates were mostly women (74%) and 55% of them were patients' spouses. Surrogates ranged in age from 18 to 75 years. Intraclass correlation coefficients levels varied across different variables ranging from lack of agreement (p>0.05) to almost perfect agreement with decision delay time having the highest correlation coefficient (86%, p<0.05). Cognitive variables had higher agreement than emotional variables. Significant emotional variables' agreement ranged form 28% to 39% and significant cognitive variables' agreement ranged form 64% to 68%. Female surrogates (n=81) had higher agreement levels with their respective patients than male surrogates (n=28). CONCLUSIONS: Utilizing surrogates to proxy patients' account of decision delay time and its cognitive predictors is practical and feasible.

Predictors of decision delay to seeking health care among Jordanians with acute myocardial infarction.

PURPOSE: To identify predictors of decision delay time for health care seeking among Jordanians with acute myocardial infarction (AMI). DESIGN: The study was a cross-sectional descriptive survey. A convenience sample of Jordanians with AMI were interviewed at the coronary care units of two teaching hospitals in Jordan. METHODS: The Arabic version of the modified Response to Symptom Questionnaire was used to assess predictors of decision delay and patterns of health care-seeking behaviors. Decision delay was evaluated by assisting patients to triangulate time of symptom onset and time of decision to seek professional health care by placing both times in context of daily activities that participants could easily remember. Regression analysis was conducted to elicit predictors of decision delay. FINDINGS: Decision delay time among Jordanian men (n=110) and women (n=24) with AMI was alarmingly long (medians 3.5 and 3.6 hours, respectively). Variables that correspondingly predicted decision delay among men and women were age, waiting for symptoms to go away, anxiety due to symptom presentation, and others' responses to patients' symptoms. While 16 other variables (cognitive, emotional, and clinical) independently predicted delay among men, equivalent evidence was not established among women due to the relatively small sample size. CONCLUSIONS: Similarities and differences existed between Jordanian men's and women's decision delay to seek health care for AMI. Decision delay time among Jordanians with AMI requires intervention that incorporates awareness of delay predictors. Future research needs to utilize adequate sample sizes of both sexes to obtain a better understanding of sex differences. CLINICAL RELEVANCE: To reduce decision delay among Jordanians, health educators should emphasize early symptom recognition and the value of prompt health care-seeking behaviors.

Predictors of pre-hospital delay among patients with acute myocardial infarction.

OBJECTIVE: To evaluate current literature on predictors of pre-hospital delay among patients with acute myocardial infarction (AMI). METHODS: Medline, CINHAL, and Psych Info databases were searched using keywords: attitude to illness/health, health beliefs, help/health seeking behavior, health behavior, psychosocial factors, treatment delay, socioeconomic factors, time factors, pre-hospital delay, and symptoms. These keywords were combined with AMI to identify literature published during 1995-2008. RESULTS: Twenty-six data-based research articles were identified. Delay varied across literature and median pre-hospital delay was often reported due to distribution skewness resulting from extremely prolonged values (1.5-15.2h). Six categories of predictors influenced pre-hospital delay; socio-demographic, symptom onset context, cognitive, affective/psychological, behavioral, and clinical factors. Pre-hospital delay was shortest when the decision to seek healthcare was facilitated by family members or coworkers and when symptoms suggestive of heart attack were continuous and severe. CONCLUSION AND PRACTICE IMPLICATIONS: Developing interventions programs to reduce pre-hospital delay for high-risk patients is warranted. Because decision delay is the only modifiable part by intervention, it is recommended that future investigations and interventions attend to decision time as the primary variable of interest instead of combining it with transportation time. Moreover, content of patient education need to emphasize on symptom awareness and recognition, and prompt and proper patient actions for optimum results. Also, in order to eliminate sampling bias resulting from investigating surviving AMI patients, it is recommended that future studies incorporate data from both surviving and surrogates of non-surviving AMI patients.

The wider scope of video-assisted thoracoscopic surgery.

In the past, rudimentary devices were used to look closely into the chest; currently, advanced video technology, computers, and high-tech electronics are being used to perform many surgical procedures that formerly required a large, open incision. The goal of video-assisted thoracoscopic surgery (VATS) is the same as for comparable open procedures, but it is accomplished with less pain, less patient morbidity, and a shorter hospital stay. In addition to evaluating and treating thoracic injuries, VATS has demonstrated effectiveness in detecting and managing many other conditions, such as pleural disease, interstitial lung disease, and thoracic malignancies.