Predictors of patient-reported health following cardiac surgery.

BACKGROUND: Patient-reported health status is one of the most important aspects of cardiovascular outcomes. The aim of this study was to assess patient-reported health and its determinants following cardiac surgery. METHODS: Cross-sectional study was performed among 128 patients (mean age: 66.02; 35.9% women). Three months after surgery patients filled in The Short Form 12 Health Survey (SF-12) and Brief-Illness Perception Questionnaire (B-IPQ). Patient-reported health was assessed using SF-12 General Health component. RESULTS: The mean General Health score was 47.34 (SD=20.94). General Health was significantly positively correlated with SF-12 Physical and Mental Component Summary (P<0.01). Significant negative correlations were noted between General Health and European System for Cardiac Operative Risk Factor (EuroSCORE) (P=0.012) and Body Mass Index (BMI) (P=0.026). Higher scores on B-IPQ Consequences, Timeline, Identity, Emotional Response (P<0.01) and Concern (P=0.03) were related to worse General Health. Higher perceived effectiveness of surgery (P<0.01) and Treatment control (P=0.003) were associated with higher General Health score. More negative illness perception was significantly related to lower General Health (P<0.01). No significant associations between General Health and mode and weight of the procedure, myocardial infarction, previous percutaneous coronary intervention, New York Heart Association (NYHA) and Canadian Cardiovascular Society (CCS) class and postsurgical complications were noted. Structural equation modeling (SEM) revealed that illness perception domains, BMI and EuroSCORE are the main determinants of General Health. CONCLUSIONS: Modifiable factors, especially illness perception are important determinants of patient-reported health after cardiac surgery. Evaluation of illness perception seems vital since it may lead to address patients' concerns and improve outcomes.

Measures of preoperative anxiety.

The evaluation of treatment from the patient's perspective (Patient Reported Outcomes, PROs) currently remains one of the most vibrant and dynamically developing fields of research. Among PROs, patient self-assessment of various symptoms, including one's psychological state, is of great importance. Anxiety is one of the most frequently observed psychological reactions among patients awaiting various surgeries, and may occur even in up to 80% of patients scheduled for high-risk surgical procedures. An increased level of preoperative anxiety has been proved to be related to negative consequences, both psychological and somatic, and affecting, in consequence, anaesthesia, postoperative care and treatment, along with the rehabilitation process. It is also considered as a risk factor for mortality in patients after surgeries. Planning of necessary educational, pharmacological and psychological interventions should be preceded by the evaluation of anxiety level which should be considered a routine element of preoperative care. The assessment of anxiety intensity may be performed using psychometric scales. Various factors should be taken into consideration while choosing the scale, including its reliability and accuracy, the aim of the assessment, the patient's age and clinical state, as well as the type of surgery being planned. In the current article, we present standardised and reliable methods which may be used in the evaluation of preoperative anxiety among patients scheduled for surgery, namely: the State-Trait Anxiety Inventory (STAI); the Hospital Anxiety and Depression Scale (HADS); the Amsterdam Preoperative Anxiety and Information Scale (APAIS); and the Visual Analogue Scale (VAS). A detailed description of the scales, including their main advantages and limitations, as well as their usefulness in both clinical evaluation of various patients' groups and scientific research are presented.

Patients' Expectations as to Doctors' Behaviors During Appointed Visits.

Numerous guidelines for students and medical professionals provide the instructions of proper behavior during encounters with patients in a doctor's office. However, they quite often do not consider cultural differences that may affect the doctor-patient relationship. In our study we analyzed Polish patients' expectations (N = 976) for their physicians' actual behavior. We compared our results with analogue studies performed in the United States. We determined that patient expectations concerning a desirable form of verbal and nonverbal communication with a physician vary to a considerable degree. Relatively universal, however, is the wish that the doctors introduce themselves and apply personalized forms of contact.

The Paradox of Waiting for Heart Transplant: Between Control and Fate.

OBJECTIVES: Understanding a patient's perspective has received increased attention. Awaiting heart transplant remains a great challenge, not only for patients and their families but also for health professionals. This particular challenge has multiple aspects, the most important being the psychological one. Understanding candidates for heart transplant is vital for all caregivers. In this study, our aim was to present the individual's experience of awaiting heart transplant. MATERIALS AND METHODS: Structured interviews and the Pictorial Representation of Illness and Self Measure, Hospital Anxiety and Depression Scale, the Illness Cognition Questionnaire, and the Illness Perception Questionnaire-Revised measurements were performed in 2 male patients (60 and 61 years old) who were on heart transplant wait list. RESULTS: The patients expressed their concerns and perceived severe consequences of heart disease. They also demonstrated the importance of significant others and hope. The results suggest the existence of realistic cognitive pictures of the disease. The patients revealed high sense of control along with the awareness of being dependent on fate. The lack of severe anxiety and depressive symptoms along with high perceived benefits' scores suggest the existence of an adaptation process. CONCLUSIONS: Awaiting heart transplant appears to be a multidimensional phenomenon. The paradoxic configuration of a high sense of control along with the awareness of being dependent on fate was apparent. Significant others and hope seem to be of great importance. The Pictorial Representation of Illness and Self Measure allows a better understanding of a patient's perspective and allows the patient to share personal views. The individual approach provides opportunities that go far beyond routine clinical assessment.

How do patients and doctors-to-be perceive systemic lupus erythematosus?

The aim of the present study was to assess and compare illness perception of systemic lupus erythematosus (SLE) held by 6th-year medical students and patients suffering from SLE. The study group consisted of 104 students (66 women; 63.5 %), mean age 24.7 (±1), and 64 outpatients with SLE (60 women; 93.7 %). All patients were treated at a university rheumatology outpatient clinic. Mean patients' age was 44.3 years (±12.5). Mean duration of the disease was 11 years (±6.8). The Polish version of Brief Illness Perception Questionnaire (B-IPQ) was used to assess five dimensions of illness perception. The students were asked to complete a modified version of B-IPQ designed to measure health professionals' illness perception. Significant differences were found in all but one B-IPQ scores. The students obtained significantly higher scores than the SLE patients in consequences, identity, concern and emotional response, whereas significantly lower scores in personal control, treatment control and understanding were noted among students. No differences were found in timeline scores. Medical students' perception of SLE is more threatening and more negative than that of patients'. Doctors-to-be perceive SLE as being less controllable, more burdensome and having more consequences than patients do. Additionally, they believe the disease causes more emotional concern. The article discusses possible explanations together with positive and negative aspects of the discrepancies.

The light-harvesting chlorophyll a/b binding proteins Lhcb1 and Lhcb2 play complementary roles during state transitions in Arabidopsis.

Photosynthetic light harvesting in plants is regulated by phosphorylation-driven state transitions: functional redistributions of the major trimeric light-harvesting complex II (LHCII) to balance the relative excitation of photosystem I and photosystem II. State transitions are driven by reversible LHCII phosphorylation by the STN7 kinase and PPH1/TAP38 phosphatase. LHCII trimers are composed of Lhcb1, Lhcb2, and Lhcb3 proteins in various trimeric configurations. Here, we show that despite their nearly identical amino acid composition, the functional roles of Lhcb1 and Lhcb2 are different but complementary. Arabidopsis thaliana plants lacking only Lhcb2 contain thylakoid protein complexes similar to wild-type plants, where Lhcb2 has been replaced by Lhcb1. However, these do not perform state transitions, so phosphorylation of Lhcb2 seems to be a critical step. In contrast, plants lacking Lhcb1 had a more profound antenna remodeling due to a decrease in the amount of LHCII trimers influencing thylakoid membrane structure and, more indirectly, state transitions. Although state transitions are also found in green algae, the detailed architecture of the extant seed plant light-harvesting antenna can now be dated back to a time after the divergence of the bryophyte and spermatophyte lineages, but before the split of the angiosperm and gymnosperm lineages more than 300 million years ago.

Very rapid phosphorylation kinetics suggest a unique role for Lhcb2 during state transitions in Arabidopsis.

Light-harvesting complex II (LHCII) contains three highly homologous chlorophyll-a/b-binding proteins (Lhcb1, Lhcb2 and Lhcb3), which can be assembled into both homo- and heterotrimers. Lhcb1 and Lhcb2 are reversibly phosphorylated by the action of STN7 kinase and PPH1/TAP38 phosphatase in the so-called state-transition process. We have developed antibodies that are specific for the phosphorylated forms of Lhcb1 and Lhcb2. We found that Lhcb2 is more rapidly phosphorylated than Lhcb1: 10 sec of 'state 2 light' results in Lhcb2 phosphorylation to 30% of the maximum level. Phosphorylated and non-phosphorylated forms of the proteins showed no difference in electrophoretic mobility and dephosphorylation kinetics did not differ between the two proteins. In state 2, most of the phosphorylated forms of Lhcb1 and Lhcb2 were present in super- and mega-complexes that comprised both photosystem (PS)I and PSII, and the state 2-specific PSI-LHCII complex was highly enriched in the phosphorylated forms of Lhcb2. Our results imply distinct and specific roles for Lhcb1 and Lhcb2 in the regulation of photosynthetic light harvesting.

PROTON GRADIENT REGULATION5 is essential for proper acclimation of Arabidopsis photosystem I to naturally and artificially fluctuating light conditions.

In nature, plants are challenged by constantly changing light conditions. To reveal the molecular mechanisms behind acclimation to sometimes drastic and frequent changes in light intensity, we grew Arabidopsis thaliana under fluctuating light conditions, in which the low light periods were repeatedly interrupted with high light peaks. Such conditions had only marginal effect on photosystem II but induced damage to photosystem I (PSI), the damage being most severe during the early developmental stages. We showed that PROTON GRADIENT REGULATION5 (PGR5)-dependent regulation of electron transfer and proton motive force is crucial for protection of PSI against photodamage, which occurred particularly during the high light phases of fluctuating light cycles. Contrary to PGR5, the NAD(P)H dehydrogenase complex, which mediates cyclic electron flow around PSI, did not contribute to acclimation of the photosynthetic apparatus, particularly PSI, to rapidly changing light intensities. Likewise, the Arabidopsis pgr5 mutant exhibited a significantly higher mortality rate compared with the wild type under outdoor field conditions. This shows not only that regulation of PSI under natural growth conditions is crucial but also the importance of PGR5 in PSI protection.