BACKGROUND: Depressive symptoms are an independent risk factor for outcome in patients with cardiac disease, but their effect on outcome among patients undergoing coronary artery bypass grafting is not well understood. OBJECTIVES: To determine whether or not clinical variables including length of stay, readmission rates, and mortality are related to patients' level of depressive symptoms before and after coronary artery bypass grafting. METHODS: An observational, longitudinal design was used. The Medical Outcomes Study 36-item short-form health survey was used to collect data on depressive symptoms in 416 patients undergoing coronary artery bypass grafting. The distribution of depressive symptoms was correlated with length of stay after the procedure, readmission, and mortality. RESULTS: The level of depressive symptoms before coronary artery bypass grafting correlated with the level of depressive symptoms at 6 weeks follow-up, both for the individual items "feeling down in the dumps" (r = 0.24, P = .009) and "feeling downhearted" (r = 0.36, P < .001) and for the overall score on the Mental Health scale (r = 0.40, P < .001). Feeling down in the dumps (P = .007) and overall scores on the Mental Health scale (P = .02) were significantly related to readmission within 6 months. CONCLUSIONS: Higher levels of depressive symptoms before coronary artery bypass grafting are related to higher hospital readmission rates 6 months after the procedure. Nurses can play a pivotal role in determining which patients require evaluation, educating patients, and initiating effective treatment, which may prevent readmission related to depressive symptoms.
BACKGROUND: Methods of converting treatment with i.v. nitroglycerin to treatment with nitroglycerin ointment 2% vary greatly and may affect the length of time patients remain in the ICU, nursing time, and possible recurrent angina. To date, no randomized, controlled studies have evaluated the methods used for conversion. OBJECTIVE: To evaluate two methods of conversion. METHODS: Two hundred patients receiving i.v. nitroglycerin at doses of 10 to 100 micrograms/min were randomized to two methods of conversion: (1) Apply nitroglycerin ointment and stop i.v. nitroglycerin 30 minutes later. (2) Decrease the dose of i.v. nitroglycerin by 10 micrograms/min every 15 minutes, apply one half the dose of nitroglycerin ointment when the original i.v. dose has been decreased by one half, and apply the full dose of the ointment when the i.v. nitroglycerin is stopped. The primary end point was the time patients remained in the ICU after the conversion. Secondary end points included time to hospital discharge, estimate of nursing time, and selected clinical end points. Kaplan-Meier and Cox regression analyses were used to evaluate time patients remained in the ICU and nursing time. Clinical outcomes were analyzed by using a chi-square test. RESULTS: Use of the first method reduced median time before transfer from the ICU by 23 minutes and median nursing time by 45 minutes. Analysis of all clinical outcomes showed no differences between the two methods. CONCLUSIONS: Use of the first method was associated with a reduction in the time patients remained in the ICU before transfer to another unit and savings in nursing time, but the two methods did not differ according to clinical outcomes.
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