This article describes a systematic review on the research into postoperative cognitive dysfunction (POCD) in noncardiac surgery to ascertain the status of the evidence and to examine the methodologies used in studies. The review demonstrated that in the early weeks after major noncardiac surgery, a significant proportion of people show POCD, with the elderly being more at risk. Minimal evidence was found that patients continue to show POCD up to 6 months and beyond. Studies on regional versus general anesthesia have not found differences in POCD. Many studies were found to be underpowered, and a number of other methodologic difficulties were identified. These include the different types of surgery in studies and variations in the number and range of neuropsychological tests used. A particular issue is the variety of definitions used to classify individuals as having POCD.

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The scores on the PQRS demonstrated an improvement over time, consistent with an expected recovery after surgery and anesthesia, and an ability to discriminate between individuals. Many patients had incomplete recovery by the third postoperative day.

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Background and Purpose-Percutaneous transluminal angioplasty (PTA) is currently being assessed for the treatment of carotid stenosis. In comparison with carotid endarterectomy (CEA), there is evidence of an increased risk of cerebral microembolism during the procedure. We have sought evidence of any neuropsychological sequelae of carotid PTA and compared it with CEA to demonstrate the relative safety of the 2 treatment options. Methods-The neuropsychological outcomes after CEA and PTA were compared in 2 matched groups of patients with severe symptomatic carotid stenosis, 96% of whom had been randomized in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS), at a single center. Transcranial Doppler insonation of the middle cerebral artery was used to measure cerebral reactivity in response to carbon dioxide inhalation before treatment and then to detect microembolization of the ipsilateral cerebral hemisphere and measure changes in blood flow velocity during the procedures. The performance on a neuropsychological test battery administered before, 6 weeks after, and 6 months after the procedure was compared in 20 patients undergoing PTA and 26 having CEA. Results-At 6 weeks, 5 patients in each group showed a similar decline in neuropsychological performance; global measures showed no significant difference between the 2 procedures, despite a significantly higher incidence of microemboli during PTA. Both groups showed a marked reduction in anxiety after treatment. Conclusions-The findings provide some reassurance that PTA is not associated with greater cerebral complications than CEA, despite the higher embolic load recorded by transcranial Doppler ultrasonography during angioplasty. (Stroke.

Using religious/spiritual resources in the coping process during the early stages of breast cancer may play an important role in the adjustment process in patients with breast cancer. Patients may benefit from having their spiritual needs addressed as experiencing some form of religious/spiritual struggle may serve as a barrier to illness adjustment. Implications for research and clinical practices are discussed.

This is the accepted version of the paper.This version of the publication may differ from the final published version. Abstract Aims: This review explores the quality of life of adult congenital heart disease patients and the relationship between disease severity and quality of life. Methods: We searched seven electronic databases and the bibliography of articles. The 31 selected studies fulfilled the following criteria: adult population; quantitative; assessment of quality of life and/or impact of disease severity on quality of life using validated measures; English language. Data extraction forms were used to summarise the results. Results: There are evident methodological limitations within the reviewed studies such as heterogeneous populations, designs, and quality of life conceptualisations and measurements. Despite these problems, findings suggest that the quality of life of adult congenital heart disease patients is compromised in the physical domain compared with their healthy counterparts, whereas no differences were found in relation to the psychosocial and environmental/occupational domain. Some severity variables appear to be significant correlates of quality of life and could be considered in a future standardised classification of disease severity. Conclusion: The methodological limitations of past research in relation to the definition and measurement of quality of life, the study designs, and disease severity classifications need to be addressed in future studies in order to provide robust evidence and valid conclusions in this area of study. This will enable the development of targeted interventions for the improvement of quality of life in the adult population of congenital heart disease patients. Permanent repository linkKeywords: Quality of life; congenital heart disease; adult; adults with congenital heart disease; GUCH; severity Received: 16 October 2012; Accepted: 9 December 2012 A PPROXIMATELY EIGHT IN 1000 CHILDREN ARE born with congenital heart disease, with approximately two-thirds requiring treatment. Owing to advances in treatment, ,90% are now expected to survive into adulthood compared with 20% 50 years ago.1 This has resulted in an estimated current population of 135,000 adult congenital heart patients in England. 2 Traditionally, the outcome in congenital heart disease has been measured in terms of mortality and functional status. There is an increasing recognition that reliance on clinical measures in determining outcomes is not sufficient as it fails to capture the patients' perspective. 3 Consequently, interest has turned to examining the quality of life of adult congenital heart disease patients. Although a universally accepted definition of quality of life does not exist, it is usefully conceptualised in three broad domains, namely, physical, psychosocial, and environmental.Research suggests that adult patients with congenital heart disease, like other patients with chronic conditions, are faced with physical health issues and psychosocial challenges. 4 A clear perspective o...

SummaryWe investigated the influence of either propofol or desflurane on the incidence of postoperative cognitive dysfunction in a randomised trial of 180 patients undergoing coronary artery bypass surgery. The primary outcome was incidence of postoperative cognitive dysfunction at 3 months, defined as ‡ 1 SD deterioration in two or more of 12 neurocognitive tests. Secondary outcomes included early postoperative cognitive dysfunction (between days three and seven), delirium on day one, morbidity and length of hospital stay. Early postoperative cognitive dysfunction was significantly higher with propofol compared with desflurane (56 ⁄ 84 (67.5%) vs 41 ⁄ 83 (49.4%), respectively, p = 0.018), but this effect was not seen at 3 months (10 ⁄ 87 (11.2%) vs 9 ⁄ 90 (10.0%), respectively. There was no difference in delirium (7 ⁄ 89 (7.9%) vs 12 ⁄ 91 (13.2%), respectively, length of hospital stay (median (IQR [range]) 7 (6-9 [4-15]) vs 6 (5-7 [5-16) days, respectively or other morbidities. Desflurane was associated with reduced early cognitive dysfunction. Postoperative cognitive dysfunction (POCD) is a common morbidity associated with coronary artery bypass surgery, ranging in frequency from 20% to 60% for between 6 weeks to 3 months after surgery [1][2][3]. It can be an enduring problem for patients, as the presence of POCD at 3 months after surgery has a high chance of persisting into the long term [3,4]. Much research has been devoted to investigating aspects of cardiopulmonary bypass that have been considered to be the most likely cause of POCD, with conflicting results. The focus on cardiopulmonary bypass, and consequent aortic manipulation required for aortic