Barriers and Promoting Strategies to Sexual Health Assessment for Patients with Coronary Artery Diseases in Nursing Practice: A Literature Review

Background: Sexual health is an important and integral part of human health. Patients often voice their concerns regarding their sexual health after experiencing coronary artery diseases. Nurses face many barriers to conduct sexual health assessment. Although many sexual health instructions have been developed, nurses still pay little attention to sexual health assessment. Purpose: The purpose of this literature review was to identify the barriers and strategies that promoted sexual health assessment in clinical nursing practice. Design: A comprehensive search of the recent literature related to barriers and promoting strategies to sexual health assessment was undertaken. Methods: A review of literature published over the last 10 years on a wide variety of recent studies in nursing and related discipline in the field of sexual health was performed. Findings: Most studies indicated that sexual health was poorly addressed in clinical settings. Barriers to addressing sexual health are multifactorial;we classified them into four categories: patients related barriers, nurses related barriers, organizational related barriers and value related barriers. Many strategies to enhance sexual health assessment and counseling in clinical setting are summarized. Conclusion: Overall, it is evident that nurses encounter many barriers to sexual health assessment. Therefore, investigating these barriers and developing appropriate interventions are recommended.

Clinical Outcomes in Patients Undergoing Triple-Vessel Angioplasty for Symptomatic Coronary Artery Disease

Current treatment strategies for multi-vessel coronary artery disease include either coronary artery bypass surgery or percutaneous coronary intervention with stenting. The present study evaluates the morbidity and mortality among coronary artery disease patients undergoing triple-vessel angioplasty. This prospective record based descriptive study was carried out in Medical College, Pariyaram, Kannur, Kerala;a tertiary care cardiac centre in South India. Fifty consecutive patients who underwent angioplasty of one or more lesions in each of the three major coronary arteries from May 2010 to July 2012 were included in the study. The study describes the clinical profile of the patients and a moderate term clinical follow-up to reassess the symptoms, functional status and left ventricular function by history, electrocardiogram, echocardiogram, and treadmill test. Mortality and morbidity were considered as end-points of the study. Event-free survival rate was 94% at a mean follow-up of 20 months. Overall 98% continued success was obtained with triple-vessel angioplasty. Triple-vessel angioplasty is a safe and effective therapy as an alternative to surgical revascularization in selected patients with triple-vessel coronary artery disease.

Illness Perception, Treatment Adherence and Coping in Persons with Coronary Artery Disease Undergoing Angioplasty

Background and Objective: Coronary artery disease (CAD) is the leading cause of sudden death. In this article, we compared patients’ illness perception (IP), treatment adherence and coping mechanisms of patients undergoing percutaneous transluminal coronary angioplasty (PTCA). Methods: In this descriptive, prospective observational study IP, treatment adherence and coping of 140 patients were evaluated pre-PTCA, at the time of hospital discharge and 1 to 3 months post-PTCA by Illness Perception Questionnaire, Morisky Treatment Adherence and Carver’s brief COPE questionnaires. Results: 1 - 3 months post-PTCA, all dimensions of IP changed significantly except personal and treatment control. Adherence scores decreased simultaneously. With respect to coping mechanisms, all increased except behavioral disengagement, emotional support, instrumental support and religion which decreased significantly post-PTCA. Conclusions: In Overall, an improved IP and increased use of controllable causal attributions led to an increase in medication adherence and adaptive coping strategies. Post-treatment health behaviors are predictable by assessing patients’ illness-related beliefs beforehand.

Conservative strategy for treatment of stable coronary artery disease

Patients with coronary artery disease vary widely in terms of prognosis, which is mainly dependent on ventricular function. In relation to the major outcomes of death and myocardial infarction, it is not clear in the literature if an invasive strategy of myocardial revascularization is superior to a conservative strategy of optimized medical therapy. Moreover, with the exception of patients with left main coronary disease, this similarity in prognosis also occurs in different subgroups of patients.

Long-term effect of stenting in unprotected left main coronary artery disease in the elderly

Objective To evaluate the feasibility,safety and efficacy of percutaneous stent implantation for treating left main coronary artery(LMCA)stenosis.Methods Consecutive patients with unprotected left main coronary artery disease treated by stent-based percutaneous intervention(PCI)at 6 medical centers in China were enrolled.Procedural data and clinical outcomes were obtained from all patients.Results From January 2001 to December 2004,138 patients(79 males and 59 females;mean age:69.7±5.8 years)underwent PCI for LMCA stenosis.Bare metal stents(BMS)were implanted in 51 patients with non-bifurcational lesions and in 5 patients with bifurcational lesions from January of 2001 to June of 2003(BMS group);.Drug eluting stents(DES)were used unselectively to cover both bifurcational and non-bifurcational lesions in 86 patients from July of 2003 to December of 2004(DES group).Procedural success rate of the 138 cases was 98%(135/138).One patient(0.7%)with bifurcation lesion who was treated with DES died from severe heart failure 2 weeks after the procedure.During a mean follow up period of 21.3±5.6 months,one patient died from renal failure,one from sudden cardiac death,4 underwent target lesion revascularization(TLR)in the BMS group,which all occurred in patients with bifurcational lesions;whereas in the DES group no deaths occurred and only one patient with bifurcational lesion had TLR.Conclusions(1)PCI is feasible and relatively safe to treat unprotected left main coronary artery disease in elderly patients at medical centers with experienced professionals.(2)BMS and DES have similar immediate and long-term efficacy in the treatment of ostium and shaft lesions of the LMCA.(3)DES are strongly suggested in the therapy of distal bifurcation lesion of unprotected LMCA.

Drug eluting balloons for the treatment of coronary artery disease: What can we expect?

Drug-eluting balloons (DEBs) represent an enhancement of the therapeutic repertoire for the interventional cardiologist. The therapeutic concept of DEBs is promising, notably on the basis of initial studies in patients with diffuse in-stent restenosis (ISR). At present, however, a number of questions regarding long-term efficacy and safety remain, specifically in indications other than diffuse ISR. The results of the evaluation of different substances, balloon systems and clinical indications will determine the long-term success of DEBs.

Clinico-Angiographic Profile and Prevalence of Restenosis in Patients Undergoing Percutaneous Transluminal Coronary Angioplasty to Left Main Coronary Artery: An Observational Cohort Study

Background: Patients who underwent percutaneous coronary intervention in left main coronary artery (LMCA) requires special concern, being high risk and increasing patient population. The aim of this study was to assess the clinical profile, angiographic status, and prevalence of restenosis in patients who underwent percutaneous transluminal coronary angioplasty (PTCA) in LMCA. Materials and Methods: This observational cohort study included 17 patients who underwent PTCA in LMCA during one-year study period at tertiary care centers in Government Medical College, Kozhikode, India. Data including various risk factors, clinical and angiographic details, stent used, procedural complications and outcomes including rate of restenosis were analyzed. Results: A total of 17 patients (mean age 53.88 ± 9.80 years) with 76.47% of males were included in the study. Smoking and hypertension were the most common risk factors presented in 52.94% and 47.06% of patients respectively. Single vessel disease (SVD) of LMCA was the most common pattern observed in 47.10%;the rate of restenosis was observed in 11.76% patients. Revascularization was performed in one patient (5.88%) with coronary artery bypass graft and in one patient (5.88%) with PTCA using drug eluting stent (DES). The overall procedural success was 88.24% in this study. Survival rate was 100% at one-year follow-up period. Conclusion: Our study involved patients who underwent PTCA in LMCA, showed smoking as a most prevalent risk factor for coronary artery disease and SVD as a most common pattern, comparatively low rate of restenosis and 100% of survival rate at one-year follow-up period.

PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY FOR COMPLICATED CORONARY ARTERY LESIONS

Objective To research the effect of percutaneous transluminalcoronary angioplasty (PTCA) on treating complicated artery lesions.Methods Type B or type C of complicated coronary artery lesionswere confirmed by selective coronary angingraphy in 16 cases with coronaryheart disease.Gruentzig’s method was used in carring out PTCA.Results Fifteen of sixteen and thirty-two of thirty-five parts ofcoronary artery lesions were dilated successfully,the success rate was 93.7%and 88.5%,respectively.In failed four parts of PTCA,three parts werebecause of the guilding wire or the balloon failed to pass the narrow arterythrough,the other one was unable to be performed for the occurrencedsevere arrthymia during the procedure.Four stents were implantend foracute accident.Symptoms of the successful cases were improved ordisappeared after PTCA.Conclusion PTCA is also fit in treating complicated coronary arterylesions and has a better therapeutic effect,but it has more complications andrun more risks relatively.

Left main coronary stenosis as a late complication of percutaneous angioplasty:an old problem,but still a problem

Objective Accelerated left main coronary stenosis (LMCS) is a known potential late complication of coronary artery catheter procedures. The aim of this study was to assess the current occurrence of LMCS as a delayed complication of percutaneous angioplasty (PTCA) of the left coronary branches in our institution. Methods The medical records of patients referred for coronary artery by-pass surgery from the same Cardiology Unit in the January 2003 to December 2006 period and presenting a significant (> 50%) LMCS as a new finding following a PTCA of the left coronary artery branches, were reviewed. Patients with retrospective evidence of any LMCS at previous coronary angiographies preceding the percutaneous procedure were excluded. Results Thirty-seven patients (5 females, mean age 71.1±8.6 years) out of 944 (4%) having undergone a PTCA, fulfilled the inclusion criteria, 19 (51%) after a procedure also involving the LAD coronary artery. Extraback-up guiding catheters were used in most cases. Use of multiple wires or balloons was observed in 3 cases (8%). Rotablator and proximal occlusion device were used in one case respectively (3%). Twenty patients (54%) have had more than one percutaneous coronary intervention on the left coronary branches. The mean time elapsed from the first angioplasty and surgical intervention was 18.1±7.8 months. Conclusions The potential occurrence of LMCS following a percutaneous intervention procedure, especially when complicated and repeated, should not be underestimated in the current era. This evidence may offer the rationale to schedule non-invasive imaging tests to monitor left main coronary patency after the procedure as well as to fuel further research to develop less traumatic materials.

Safety and efficacy of dalteparin in percutaneous coronary intervention in Chinese patients with non-ST-elevation acute coronary artery syndromes： comparison with unfractionated heparin

Objective To prospectively evaluate the safety and therapeutic efficacy ofdalteparin in patients with high risk non-ST- elevation acute coronary syndromes （ACS） during percutaneous coronary intervention （PCI）. Methods A total of 175 patients with high risk non-ST-elevation ACS were randomly assigned to 2 groups [dalteparin group and unfractionated heparin （UFH） group]. The patients in dalteparin group were given dalteparin at a dose of 5,000U subcutaneously soon after diagnosis and then an additional 60U/ kg intravenous bolus ofdalteparin before emergent PCI. Vascular access sheaths were removed immediately after PCI or coronary artery angiography; the patients in UFH group were given UFH intravenously at a dose of 25mg just before PCI and an additional 65mg bolus was administered if angiographic findings showed that the patients were suitable for percutaneous transluminal coronary angioplasty （PTCA）. Sheaths were removed at 4-6 hours after PCI; Results Eighty-three patients in dalteparin group underwent PCI while 82 patients in UFH group underwent PCI; anti-Xa activities of 52 patients in daltepafin group were measured. The average anti-Xa activity was （0. 83± 0.26） U/ml at 15 minutes after intravenous injection of dalteparin and anti-Xa〉0.SU/ml was obtained in 96.1% of the patients; hematomas at puncture sites were significantly fewer in dalteparin group as compared with UFH group （2.3% vs 9.2%, P 〈 0.05）; none of the patients in 2 groups suffered major bleeding events. No death, acute arterial reocclusion or emergent revascularization events occurred at 30 days after PCI. Conclusions Our study demonstrated that early subcutaneous injection ofdalteparin at a dose 5,000U after diagnosis and an additional 60U/kg intravenous bolus ofdalteparin before PCI is safe and efficacious for patients with high risk non-ST-elevation ACS undergoing emergent PCI.

Nursing care of 25 children with Kawasaki disease

Objective The aim of this study is to estimate the incidence and describe the diagnosis,treatment and nursing care of Kawasaki Disease among children in Guilin city,Guangxi Province,China.The study is also designed to assess clinical aspects of retrospection,management and outcome,specifically in relation to cardiac disease.Methods To retrospectively collected the clinical data of pediatric patients with Kawasaki's disease at the Affiliated Hospital of Guilin Medical University in China,which covered a two-year period from 2015 to 2016.Results During the two-year study period,a total of 25 cases of Kawasaki disease were reported in the hospitals,comprising of 11 boys and 14 girls(male-female ratio was 1∶1.27).The seasonal distribution showed a slightly higher incidence in spring and summer.The patients’mean age of onset was 2.78 years old.The average hospitalization days of patients were 8.08(range from 5 to18days).16 Kawasaki patients were diagnosed as bronchial pneumonia.Coronary arterial abnormalities were detected during follow up by UCG in 5 cases,but no coronary artery aneurysm was found.All 25 patients recovered and were discharged from the hospital.Conclusion Early treatment and proper nursing management are key issues to prevent the occurrence of coronary artery aneurysm in Kawasaki Disease patients.

Effects of multiple nursing cares on quality of life in individuals with coronary artery disease complicated with diabetes mellitus

Patients with coronary artery disease （CAD） complicated with diabetes mellitus （DM） have a reduced quality of life （QOL） partly due to their limited range of physical activity and independence. The primary objective of this study was to examine the effect of the application of the multiple nursing cares on QOL and de- pressive symptoms in individuals with CAD complicated with DM. Methods A total of 82 CAD complicated with DM patients in Guangdong General Hospital from January 2014 to January 2015 were selected, and random- ly divided into control group （n = 41） and experimental group （n = 41） according to World Health Organization DM diagnosis criteria. The subjects in control group received routine nursing care, and the subjects in experimen- tal group were treated with the multiple nursing cares additionally for a 10-week period. The outcome measures include the Short Form-36 Health Survey （SF-36）, and Self-Rating Anxiety Scale （SAS）. Results Following 10-week intervention, the QOL scores and SAS anxiety scores in all groups were improved （P 〈 0.05）. In addi- tion, QOL and SAS anxiety scores in the experimental group were significantly improved （P 〈 0.05）, when com- pare with the control group. Conclusions Based on the results of this study, the application of the multiple nurs- ing cares to individuals with CAD complicated with DM is effective in increasing selected aspects of a general QOL and improving the anxiety situation in individuals with CAD complicated with DM. It is worthwhile to be widely used in clinical practice.

Comparison of pre-dilation with a non-compliant balloon versus a dual wire scoring balloon for coronary stenting

Purpose: The aim of this study was to determine the influence of lesion preparation using the dual wire scoring balloon on stent expansion and long-term outcomes. Methods: Forty-six consecutive de novo lesions treated with a single >2.5 mm drug-eluting stent under intravascular ultrasound guidance, using two implantation strategies, were randomly assigned to: 1) pre-dilation with a non-compliant balloon (NC group;n = 23) or 2) pre-dilation with a dual wire scoring balloon (DS group;n = 23). Results: Although the balloon size and the maximal dilation pressure for pre-dilatation was larger (3.33 ± 0.28 vs 3.09 ± 0.33 mm, p = 0.01) and higher (11.6 ± 3.2 vs 8.6 ± 2.7 atm,

FTS护理在冠脉搭桥手术患者围手术期中的应用效果

目的探讨加速康复外科(FTS)护理在冠脉搭桥手术(CABG)患者围手术期中的应用效果。方法选择2021年7月至2022年7月河南省胸科医院收治的接受常规围手术期护理的43例CABG患者作为研究对象,将其纳入对照组。另选取2022年8月至2023年8月医院收治的接受FTS围手术期护理的43例CABG患者作为研究对象,将其纳入观察组。两组均连续护理至患者出院,并随访3个月,比较两组患者围手术期指标[重症加强护理病房(ICU)监护时间、首次排气时间、下床活动时间、住院时间];比较不同时点(麻醉诱导前、血管吻合时、术毕时)两组应急指标(呼吸、心率、平均动脉压);比较两组护理前、护理3个月时心功能指标[左室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)]。结果住院期间,观察组ICU监护、首次排气、下床活动及平均住院时间均短于对照组(P<0.05);血管吻合时,两组患者呼吸、心率及平均动脉压均高于麻醉诱导前;术毕时,呼吸、心率及平均动脉压均低于血管吻合时,呈先上升后下降,观察组各时点均低于对照组(P<0.05);护理3个月时,两组LVEF高于护理前,LVESD及LVEDD低于护理前,观察组LVEF高于对照组,LVESD及LVEDD低于对照组(P<0.05)。结论FTS护理能够有效降低CABG患者应急反应,促进术后恢复,提高患者心功能。

经腔镜采集桡动脉行冠状动脉旁路移植术患者的术后护理

总结21例经腔镜采集桡动脉行冠状动脉旁路移植术患者的术后护理经验。术后护理要点包括预防桥血管痉挛,控制心率和血压,做好容量管理、血气指标监测、抗栓治疗护理、手术切口护理及患肢康复护理。21例患者采集桡动脉的伤口均Ⅰ期愈合。随访11~26个月,无1例患者出现桥血管堵塞现象,均未发生心绞痛复发及心肌梗死。

老年冠心病患者冠状动脉搭桥术后恐动症水平变化轨迹及核心影响因素决策树分析

目的了解老年冠心病患者冠状动脉搭桥术后1周至3个月恐动症变化轨迹,分析不同恐动症变化轨迹亚型的影响因素。方法选择164例行冠状动脉搭桥手术治疗的老年冠心病患者为研究对象,采用心脏恐动症量表分别于患者术后1周、术后2周、术后1个月、术后3个月进行恐动症水平调查,使用潜变量增长混合模型识别老年冠心病患者冠状动脉搭桥术后恐动症轨迹亚型,应用决策树模型分析影响恐动症变化轨迹亚型的核心影响因素。结果老年冠心病患者术后不同时段恐动症得分水平呈回升降低趋势。通过模型拟合识别出两条恐动症变化轨迹。决策树模型显示,预测变量重要性依次为年龄、运动益处认知、性别、高血压、自我感受负担、术后疼痛、术后并发症,其中年龄是最为重要的预测因素。结论老年冠心病患者术后分为持续下降和回升下降两条恐动症变化轨迹,年龄是其核心影响。应根据上述因素辨别术后可能进展为恐动症回升下降人群,并构建以提高运动益处认知和自我感受负担水平为侧重点的干预方案,以降低其恐动症水平。

行为转变理论干预对冠心病患者动脉狭窄程度、体征及生活方式和质量影响

目的:探索基于行为转变理论的干预措施对冠心病患者动脉狭窄程度、症状、生命体征、生活方式和生活质量的影响。方法:选择2019年10月~2022年12月我院收治的126例冠心病患者并随机分为对照组、研究组,每组63例。所有患者均给予基础护理,包括用药指导、心理干预等,研究组联合应用基于行为转变理论的干预措施,两组均持续干预3个月。比较两组患者干预前后的动脉狭窄程度、临床症状、体征、生活方式和生活质量。结果:与对照组比较,干预后研究组左室射血分数(LVEF)[(46.84±2.09)%比(52.87±2.44)%]、健康促进生活方式量表Ⅱ(HPLP-Ⅱ)[(105.73±8.79)分比(133.05±9.87)分]、生活质量综合评定问卷-74(GQOLI-74)[(179.72±4.28)分比(195.02±4.11)分]与西雅图心绞痛量表(SAQ)[(71.16±4.35)分比(88.68±10.82)分]评分均显著升高,左室舒张末容积(LVEDV)[(72.50±3.25)ml比(66.81±3.70)ml]、左室舒张末内径(LVEDd)[(50.76±2.81)mm比(43.48±2.27)mm]和Gensini积分[(28.39±1.64)分比(21.41±2.05)分]均显著降低,P均=0.001。结论:基于行为转变理论干预能够显著改善冠心病患者动脉狭窄程度、临床症状和体征,促进患者健康生活方式的养成,提高生活质量。

基于信息不对称理论的共同决策护理在糖尿病外周动脉疾病经皮腔内血管成形术患者中的应用效果

目的:观察基于信息不对称理论的共同决策护理在糖尿病外周动脉疾病经皮腔内血管成形术(PTA)患者中的应用效果。方法:回顾性分析2021年12月至2023年3月该院收治的86例糖尿病外周动脉疾病PTA患者的临床资料,按照护理方法不同将其分为对照组和观察组各43例。对照组实施常规护理,观察组在对照组基础上实施基于信息不对称理论的共同决策护理。比较两组依从性评分,护理前后负性情绪[焦虑自评量表(SAS)、抑郁自评量表(SDS)]、自我感受负担[自我感受负担量表(SPBS)]评分,护理满意度[纽卡斯尔护理满意度量表(NSNS)]评分,以及并发症发生率。结果:观察组药物使用、每日病情自查及复查、饮食与运动等依从性评分均高于对照组,差异有统计学意义(P<0.05);护理后,两组SAS、SDS评分均低于护理前,且观察组低于对照组,差异有统计学意义(P<0.05);护理后,两组身体因素、情感因素、经济因素等SPBS各维度评分均低于护理前,且观察组低于对照组,差异有统计学意义(P<0.05);观察组NSNS评分高于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为6.98%(3/43),低于对照组的23.26%(10/43),差异有统计学意义(P<0.05)。结论:基于信息不对称理论的共同决策护理应用于糖尿病外周动脉疾病PTA患者可提高依从性评分和护理满意度评分,降低负性情绪、自我感受负担评分和并发症发生率,效果优于单纯常规护理。

全程护理干预对预防冠脉介入诊疗术后拔鞘并发迷走神经反射的干预效果

目的探讨实施全程护理干预对预防冠状动脉介入诊疗术后拔鞘并发迷走神经反射的干预效果。方法按照随机数字表法将2022年10月至2023年10月于我院行冠状动脉介入诊疗的患者200例分为两组,各100例。采用常规护理干预的患者纳入对照组,采用全程护理干预的患者纳入观察组。两组患者均干预至出院。比较两组血管迷走神经反射发生率、负面情绪[焦虑自评量表(SAS)、抑郁自评量表(SDS)]、生活质量[诺丁汉健康量表(HNP)]和护理满意度。结果与对照组相比,观察组血管迷走神经反射发生率较低(P<0.05);与对照组相比,观察组干预后的SAS、SDS评分均较低(P<0.05);与对照组相比,观察组干预后躯体活动、疼痛、情感反应、社会生活、睡眠、精力评分较低(P<0.05);与对照组相比,观察组出院时护患沟通、操作水平、病房环境、患者感受评分较高(P<0.05)。结论对行冠状动脉介入诊疗的患者实施全程护理干预能够有效预防和减少血管迷走神经反射的发生率,并利于减轻患者负面情绪,从而促进患者的生活质量和护理满意度的提高。

早期心脏康复干预对瓣膜并搭桥患者睡眠质量及效果分析

目的:探析早期心脏康复干预对瓣膜并搭桥患者的应用价值及对睡眠质量构成的影响。方法:选取2023年1月至2023年12月福建医科大学附属协和医院收治的瓣膜性心脏病患者72例作为研究对象,按照随机数字表法分为对照组和观察组,每组36例。对照组实施常规护理,观察组实施早期心脏康复干预,对比护理效果,评估指标包含睡眠质量、心功能水平、生命质量。结果:2组患者干预后睡眠质量评分均提高,且观察组各评估项目测定数值高于对照组,差异有统计学意义(P<0.05);干预后,心功能水平有所改善,差异有统计学意义(P<0.05);评估2组患者生命质量,观察组测定数值偏高,差异有统计学意义(P<0.05)。结论:瓣膜并搭桥患者早期心脏康复干预具有较高的可行性,依照患者护理需求进行康复计划制定,不仅可以满足患者康复需求,促进心功能恢复还能够提高整体生命质量。