Thesis advisor: Dorothy A. Jones / Cardiac surgery is frequently performed as a surgical intervention within the United States; but there is little known about how the older adult (70 years of age or greater) experiences cardiac surgery and recovery over time. This qualitative research study utilized narrative methodology to interview 13 older adults to inform understanding of the older adult's cardiac surgical experience. The purpose of this study was to describe the story of the older adult both coming to surgery (preoperative period) and during the transitional time of the acute recovery period following cardiac surgery (up to 8 weeks after cardiac surgery). The primary research question asked was "What stories do older adults tell of their experience of cardiac surgery from the preoperative period through the first 2 months postoperatively?" Using narrative analysis of participant discourse, consisting of both structural (re-storying of narrative content) and thematic analysis of interview content, there emerged an overarching story of older adult experience of cardiac surgery which can be described thematically as: Moving toward healing: engaged in and appreciating life while conscious of time passing amidst the primacy and struggle of the symptom experience. Knowledge gained from this study can help to broaden the understanding of the experience and the trajectory of older adult recovery after cardiac surgery, and also serves to inform nursing education and practice models, nursing interventions, instrument development and innovative models of care designed to support the perioperative care of older adults. / Thesis (PhD) — Boston College, 2015. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Background: Coronary heart disease (CHD) is a leading cause of death in Canada; however, physical activity (PA) has been shown to reduce mortality. Unfortunately, CHD patients are not engaging in enough PA. Purpose: To explore the association of the environmental variables (a) rurality, (b) access to PA opportunities, and (c) community socio-economic status (SES) with PA in CHD patients 3 months after discharge? And how does task self-efficacy may mediate these associations Results: Regressions showed that task self-efficacy predicted PA; however rurality, and SES did not predict PA at 3 months, nor did access to PA opportunities with the exclusion of pools. The lack of associations required no mediational analyses to be performed, except for pools, which demonstrated no mediational influence from self-efficacy. Conclusion: While task self-efficacy was a key PA correlate, there were no associations between the environment and PA (with the exclusion of access to pools).

No description available.

<p> This study investigated the circulatory response to double-arm weightlifting exercise and compared the responses during free weight and machine equipment weightlifting in eight patients (mean age = 57.6±10 years) with well-documented coronary artery disease. Subjects performed bench press and overhead press exercises at 40 and 60% of 1 repetition maximum using both the free weights and machine equipment. Intra-arterial pressure was measured in the subclavian artery using a Millar catheter-tip pressure transducer. Arterial pressures rose in parallel with both modes of lifting (free weight and machine equipment), while heart rate did not increase substantially. Mean peak systolic (169 to 197 mmHg) and diastolic (95 to 119 mmHg) pressures recorded during the final repetitions of each weightlifting set did not, however, exceed values considered to be acceptable for dynamic exercise. Individual subjects recorded diastolic pressures as high as 150 mmHg during one or more of the weightlifting exercises, and individual mean arterial pressures reached values as high as 181 mmHg during overhead press machine equipment exercise at 60% of 1RM. While these high arterial pressures associated with weightlifting exercise increased myocardial oxygen demand (RPP=9643 to 15290), the increase in diastolic pressure may have augmented oxygen supply (DPTI=3448 to 3926 mmHg.s.min-1). However, because of the proportionately larger increase in RPP compared to DPTI, the ratio of oxygen supply to demand decreased with arm weightlifting exercise (DPTI:RPP=0.3741 to 0.2629). Nevertheless, the estimated myocardial oxygen supply to demand relationship appears to be more favourable during double-arm weightlifting exercise compared to estimated values from previous maximal cycle ergometer testing. These results suggest that double-arm weightlifting exercise at 40 to 60% of 1RM is safe and appropriate for patients with coronary artery disease and can be performed using either free weights or machine weightlifting equipment.</p> / Thesis / Master of Science (MSc)

Tratou-se de início o problema da reabilitação do cardíaco a partir de uma fundamentação de seus conceitos e análise de sua história. Em seguida estudou-se os aspectos orgânico, social e psíquico que influem no atendimento do paciente coronariano. A partir destes elementos elaborou-se uma metodologia para a reabilitação deste tipo de paciente. Ressaltou-se a importância da equipe de atendimento, bem como recursos de equipamento e planta física. Caracterizou-se a equipe como multiprofissional e multidisciplinar e definiu-se suas atribuições. Estudou-se a situação atual da reabilitação cardíaca no Brasil, com a finalidade de possibilitar o planejamento e a organização de um serviço de reabilitação para o paciente cardíaco, devido ao aumento da morbimortalidade por doença coronariana. Procurou-se determinar a localização geográfica, a situação e os tipos de serviços de reabilitação cardíaca no Brasil, usando-se questionários enviados pelo correio aos serviços de cardiologia do país, indexados no Anuário Estatístico. Realizou-se a análise in loco dos serviços de reabilitação cardíaca da capital do Estado de São Paulo. Posteriormente, comparou-se os demais serviços com o Instituto \"Dante Pazzanese\" de Cardiologia (IDPC). Para se obter dados mais precisos analisou-se a planta física, os recursos humanos, o equipamento, a administração e a avaliação dos serviços de reabilitação cardíaca. Verificou-se que os serviços de reabilitação cardíaca estão localizados apenas nas Regiões Sul (5) e Sudeste (15), incluindo o IDPC. Foi verificado que nas Regiões Sul e Sudeste encontram-se 64.571.000 habitantes o que eventualmente poderá gerar 6.457 cardiopatas. Nestas mesmas áreas notou-se que existe um cardiologista para atender 1.793.638 habitantes. Constatou-se, por outro lado, que as necessidades em área para condicionamento físico, salas para atendimento, pessoal e equipamento necessário são bastante deficientes nas duas Regiões, principalmente quando comparadas à organização do IDPC, que foi utilizada como padrão. Concluiu-se pela necessidade de se encarar a reabilitação cardíaca como um processo dinâmico, que depende do trabalho da equipe, do equipamento, da planta física, da orientação e educação do paciente e seus familiares, da motivação da comunidade, e que o serviço de reabilitação cardíaca não pode estar desvinculado do Hospital e da Comunidade para a qual foi criado. É necessária a preparação de equipes multidisciplinares para suprir as Regiões carentes em reabilitação do paciente cardíaco, bem como a criação de unidades que atendam às necessidades. / The problem of the cardiac patient rehabilitation was initially studied, taken into consideration its concepts and its clinical history. Next, organic, social and psychological aspects that influence the attendance of coronary patients were studied. Based on these elements, rehabilitation methodology for these patients was elaborated. The importance of the attending team, as well as of equipment and physical plant, was stressed. The team was characterized as a multiprofessional and multidisciplinary one and the role of each member was defined. The current situation of cardiac rehabilitation in Brazil was studied, in order to facilitate the planning and organization of a rehabilitation service for cardiac patients, since morbidity and mortality caused by coronary disease are increasing. An attempt was done in order to point out the geographic area, the actual situation and the types of the cardiac rehabilitation services in Brasil. This was done by means of a questionnaire mailed to the indexed services in the \"ANUÁRIO ESTATÍSTICO DO BRASIL\". Concomitantly, an analysis \"in loco\" of the cardiac rehabilitation services in São Paulo City was performed and latter on all services were compared to Instituto \"Dante Pazzanese\" de Cardiologia. In order to obtain more precise data, the plant, human resources, equipment, administration and evaluation of services were analysed. It was found that the cardiac rehabilitation services are located in the southerhand south-eastern areas of Brazil only, where we can find 64.571,000 inhabitants which can eventually present 6.457 cases of cardiopathy. These areas present 1 (one) cardiologist to attend to 1,793,638 inhabitants. On the other hand, the existing material and equipment, as well as appropriate buildings are deficient in both areas, mainly when compared to IDPC organization, that was used as model. It was concluded that we must consider cardiac rehabilitation as a dynamic process, dependant on the work of a team, on the equipment, on the building, on the orientation and education of the patient and his family, on the motivation of the community, and that the cardiac rehabi1itation service cannot be separated Cdetached) from the Hospital and the community it was created for.

Tratou-se de início o problema da reabilitação do cardíaco a partir de uma fundamentação de seus conceitos e análise de sua história. Em seguida estudou-se os aspectos orgânico, social e psíquico que influem no atendimento do paciente coronariano. A partir destes elementos elaborou-se uma metodologia para a reabilitação deste tipo de paciente. Ressaltou-se a importância da equipe de atendimento, bem como recursos de equipamento e planta física. Caracterizou-se a equipe como multiprofissional e multidisciplinar e definiu-se suas atribuições. Estudou-se a situação atual da reabilitação cardíaca no Brasil, com a finalidade de possibilitar o planejamento e a organização de um serviço de reabilitação para o paciente cardíaco, devido ao aumento da morbimortalidade por doença coronariana. Procurou-se determinar a localização geográfica, a situação e os tipos de serviços de reabilitação cardíaca no Brasil, usando-se questionários enviados pelo correio aos serviços de cardiologia do país, indexados no Anuário Estatístico. Realizou-se a análise in loco dos serviços de reabilitação cardíaca da capital do Estado de São Paulo. Posteriormente, comparou-se os demais serviços com o Instituto \"Dante Pazzanese\" de Cardiologia (IDPC). Para se obter dados mais precisos analisou-se a planta física, os recursos humanos, o equipamento, a administração e a avaliação dos serviços de reabilitação cardíaca. Verificou-se que os serviços de reabilitação cardíaca estão localizados apenas nas Regiões Sul (5) e Sudeste (15), incluindo o IDPC. Foi verificado que nas Regiões Sul e Sudeste encontram-se 64.571.000 habitantes o que eventualmente poderá gerar 6.457 cardiopatas. Nestas mesmas áreas notou-se que existe um cardiologista para atender 1.793.638 habitantes. Constatou-se, por outro lado, que as necessidades em área para condicionamento físico, salas para atendimento, pessoal e equipamento necessário são bastante deficientes nas duas Regiões, principalmente quando comparadas à organização do IDPC, que foi utilizada como padrão. Concluiu-se pela necessidade de se encarar a reabilitação cardíaca como um processo dinâmico, que depende do trabalho da equipe, do equipamento, da planta física, da orientação e educação do paciente e seus familiares, da motivação da comunidade, e que o serviço de reabilitação cardíaca não pode estar desvinculado do Hospital e da Comunidade para a qual foi criado. É necessária a preparação de equipes multidisciplinares para suprir as Regiões carentes em reabilitação do paciente cardíaco, bem como a criação de unidades que atendam às necessidades. / The problem of the cardiac patient rehabilitation was initially studied, taken into consideration its concepts and its clinical history. Next, organic, social and psychological aspects that influence the attendance of coronary patients were studied. Based on these elements, rehabilitation methodology for these patients was elaborated. The importance of the attending team, as well as of equipment and physical plant, was stressed. The team was characterized as a multiprofessional and multidisciplinary one and the role of each member was defined. The current situation of cardiac rehabilitation in Brazil was studied, in order to facilitate the planning and organization of a rehabilitation service for cardiac patients, since morbidity and mortality caused by coronary disease are increasing. An attempt was done in order to point out the geographic area, the actual situation and the types of the cardiac rehabilitation services in Brasil. This was done by means of a questionnaire mailed to the indexed services in the \"ANUÁRIO ESTATÍSTICO DO BRASIL\". Concomitantly, an analysis \"in loco\" of the cardiac rehabilitation services in São Paulo City was performed and latter on all services were compared to Instituto \"Dante Pazzanese\" de Cardiologia. In order to obtain more precise data, the plant, human resources, equipment, administration and evaluation of services were analysed. It was found that the cardiac rehabilitation services are located in the southerhand south-eastern areas of Brazil only, where we can find 64.571,000 inhabitants which can eventually present 6.457 cases of cardiopathy. These areas present 1 (one) cardiologist to attend to 1,793,638 inhabitants. On the other hand, the existing material and equipment, as well as appropriate buildings are deficient in both areas, mainly when compared to IDPC organization, that was used as model. It was concluded that we must consider cardiac rehabilitation as a dynamic process, dependant on the work of a team, on the equipment, on the building, on the orientation and education of the patient and his family, on the motivation of the community, and that the cardiac rehabi1itation service cannot be separated Cdetached) from the Hospital and the community it was created for.

The Geriatric Depression Scale (GDS) was originally designed as a measure for screening depression among elderly medical patients. Although this instrument is well validated among a general medical population, it has never been evaluated with specific regard to cardiac patients, the largest single group of medical patients over 40 years of age. A general cardiac sample of 655 patients completed the GDS within 10 weeks of the cardiac event. Exploratory factor analyses were conducted on the main sample, then on several subgroups of participants with regard to diagnostic category, gender, and age. The GDS generally produces factor structures with several symptom domains with a high rate of total variance. The myocardial infarction group endorsed general symptoms of depression whereas the coronary artery bypass graft group reported greater levels of despair regarding their condition. Overall, males primarily reported agitation and hopelessness while females reported symptoms of depressed mood.