A qualitative study of the spouse's experience following coronary artery bypass surgery: Implications for Nursing Practice

Findings from numerous quantitative studies suggest that spouses of patients undergoing Coronary Artery Bypass (CAB) surgery experience both physical and emotional stress before and after their partner's surgery. Such studies have contributed to our understanding of the spouses' experiences, however they have largely failed to capture the qualitative experience of what it is like to be a spouse of a partner who has undergone CAB surgery. The objective of this study was to describe the experience of spouses of patients who had recently undergone CAB surgery. This study was guided by Husserl's phenomenological approach to qualitative research. In accordance with the nature of phenomenological research the number of participants necessarily needs to be small because phenomenology values the unique experience of individuals. Therefore this study gathered data from four participants utilising open ended indepth interviews. The method of analysis was adapted from Amedeo Giorgi's five step empirical phenomenological process which brackets preconceived notions, reducing participants' accounts to the essential essence or meanings. Numerous themes common to each of the spouses emerged. These included: seeking information; the necessity for rapid decision making; playing guardian; a desire to debrief with their partner and lastly, uncertainty of their future role. This study has attempted to understand the phenomena of the spouse's experience and in doing so, believe that we now have a better understanding and insight into the needs of spouses of CAB surgery patients. This has added another dimension to our existing body of knowledge and further facilitates holistic patient care.

Effect of inflow and outflow angles on the computational hemodynamics in abdominal aortic aneurysm

To help with the clinical screening and diagnosis of abdominal aortic aneurysm (AAA), we evaluated the effect of inflow angle (IA) and outflow bifurcation angle (BA) on the distribution of blood flow and wall shear stress (WSS) in an idealized AAA model. A 2D incompressible Newtonian flow is assumed and the computational simulation is performed using finite volume method. The results showed that the largest WSS often located at the proximal and the distal end of the AAA. An increase in IA resulted in an increase in maximum WSS. We also found that WSS was maximal when BA was 90°. IA and BA are two important geometrical factors, they may help with AAA risk assessment along with the commonly used AAA diameter.

Comparison between computational models of abdominal aortic aneurysm

Objective: To compare the differences in the hemodynamic parameters of abdominal aortic aneurysm (AAA) between fluid-structure interaction model (FSIM) and fluid-only model (FM), so as to discuss their application in the research of AAA. Methods: An idealized AAA model was created based on patient-specific AAA data. In FM, the flow, pressure and wall shear stress (WSS) were computed using finite volume method. In FSIM, an Arbitrary Lagrangian-Eulerian algorithm was used to solve the flow in a continuously deforming geometry. The hemodynamic parameters of both models were obtained for discussion. Results: Under the same inlet velocity, there were only two symmetrical vortexes in the AAA dilation area for FSIM. In contrast, four recirculation areas existed in FM; two were main vortexes and the other two were secondary flow, which were located between the main recirculation area and the arterial wall. Six local pressure concentrations occurred in the distal end of AAA and the recirculation area for FM. However, there were only two local pressure concentrations in FSIM. The vortex center of the recirculation area in FSIM was much more close to the distal end of AAA and the area was much larger because of AAA expansion. Four extreme values of WSS existed at the proximal of AAA, the point of boundary layer separation, the point of flow reattachment and the distal end of AAA, respectively, in both FM and FSIM. The maximum wall stress and the largest wall deformation were both located at the proximal and distal end of AAA. Conclusions: The number and center of the recirculation area for both models are different, while the change of vortex is closely associated with the AAA growth. The largest WSS of FSIM is 36% smaller than that of FM. Both the maximum wall stress and largest wall displacement shall increase with the outlet pressure increasing. FSIM needs to be considered for studying the relationship between AAA growth and shear stress.

Association between aneurysm shoulder stress and abdominal aortic aneurysm expansion: A longitudinal follow-up study

Background Aneurysm expansion rate is an important indicator of the potential risk of abdominal aortic aneurysm (AAA) rupture. Stress within the AAA wall is also thought to be a trigger for its rupture. However, the association between aneurysm wall stresses and expansion of AAA is unclear. Methods and Results Forty-four patients with AAAs were included in this longitudinal follow-up study. They were assessed by serial abdominal ultrasonography and computed tomography scans if a critical size was reached or a rapid expansion occurred. Patient-specific 3-dimensional AAA geometries were reconstructed from the follow-up computed tomography images. Structural analysis was performed to calculate the wall stresses of the AAA models at both baseline and final visit. A nonlinear large-strain finite element method was used to compute the wall-stress distribution. The relationship between wall stresses and expansion rate was investigated. Slowly and rapidly expanding aneurysms had comparable baseline maximum diameters (median, 4.35 cm [interquartile range, 4.12 to 5.0 cm] versus 4.6 cm [interquartile range, 4.2 to 5.0 cm]; P=0.32). Rapidly expanding AAAs had significantly higher shoulder stresses than slowly expanding AAAs (median, 300 kPa [interquartile range, 280 to 320 kPa] versus 225 kPa [interquartile range, 211 to 249 kPa]; P=0.0001). A good correlation between shoulder stress at baseline and expansion rate was found (r=0.71; P=0.0001). Conclusion A higher shoulder stress was found to have an association with a rapidly expanding AAA. Therefore, it may be useful for estimating the expansion of AAAs and improve risk stratification of patients with AAAs.

Computed wall stress may predict the growth of abdominal aortic aneurysm

Growth rate of abdominal aortic aneurysm (AAA) is thought to be an important indicator of the potential risk of rupture. Wall stress is also thought to be a trigger for its rupture. However, stress change during the expansion of an AAA is unclear. Forty-four patients with AAAs were included in this longitudinal follow-up study. They were assessed by serial abdominal ultrasonography and computerized tomography (CT) scans if a critical size was reached or a rapid expansion occurred. Patient-specific 3-dimensional AAA geometries were reconstructed from the follow-up CT images. Structural analysis was performed to calculate the wall stresses of the AAA models at both baseline and final visit. A non-linear large-strain finite element method was used to compute the wall stress distribution. The average growth rate was 0.66cm/year (range 0-1.32 cm/year). A significantly positive correlation between shoulder tress at baseline and growth rate was found (r=0.342; p=0.02). A higher shoulder stress is associated with a rapidly expanding AAA. Therefore, it may be useful for estimating the growth expansion of AAAs and further risk stratification of patients with AAAs.

Non-invasive MR imaging of inflammation in a patient with both asymptomatic carotid atheroma and an abdominal aortic aneurysm: A case report

Inflammation is a recognized risk factor for the vulnerable atherosclerotic plaque. USPIO-enhanced MRI imaging is a promising non-i nvasive method to identify high-risk atheromatous plaque inflammation in vivo in humans, in which areas of focal signal loss on MR images have been shown to correspond to the location of activated macrophages, typically at the shoulder regions of the plaque. This is the first report in humans describing simultaneous USPIO uptake within atheroma in two different arterial territories and again emphasises that atherosclerosis is a truly systemic disease. With further work, USPIO-enhanced MR imaging may be useful in identifying inflamed vulnerable atheromatous plaques in vivo, so refining patient selection for intervention and allowing appropriate early aggressive pharmacotherapy to prevent plaque rupture.

Improving the outcomes of foot and ankle surgery. Professional impact of the Australasian College of Podiatric Surgeons' audit tool

Background Surgery is an example of expanded practice scope that enhances podiatry and incorporates inter-professional collaboration. By 2050 demand for foot and ankle procedures is predicted to rise nationally by 61.9%. Performance management of this increase motivated the development of an online audit tool. Developed in collaboration with the Australasian College of Podiatric Surgeons (ACPS), the ACPS audit tool provides real-time data capture and reporting. It is the first audit tool designed in Australia to support and improve the outcomes of foot and ankle surgery. Methods Audit activity in general, orthopaedic, plastic and podiatric surgery was examined using a case study design. Audit participation enablers and barriers were explored. Case study results guided a Delphi survey of international experts experienced or associated with foot and ankle surgery. Delphi survey-derived consensus informed modification of a generic data set from the Royal Australasian College of Surgeons (RACS). Based on the Delphi survey findings the ACPS online audit tool was developed and piloted. Reliability and validity of data entry and usability of this new tool was then assessed with an online survey. Results The case study found surgeon attitudes and behaviours positively impacted audit participation, and also indicated that audit data should be: (1) available in real time, (2) identify practice change, (3) applicable for safety and quality management, and; (4) useful for peer review discussion. The Delphi process established consensus on audit variables to be captured, including the modified RACS generic data set. 382 cases of foot and ankle surgery were captured across 3 months using the new tool. Data entry was found to be valid and reliable. Real-time outcome reporting and practice change identification impacted positively on safety and quality management and assisted peer review discussion. An online survey showed high levels of usability. Conclusions Surgeon contribution to audit tool development resulted in 100% audit participation. The data from the ACPS audit tool supported the ACPS submission to the Medical Services Advisory Committee to list podiatric surgery under Medicare, an outcome noted by the Federal Minister of Health.

Diabetic charcot neuroarthropathy of the knee: Conservative treatment options as alternatives to surgery

In contrast to the well-known Charcot neuroarthropathy (CN) of the foot, CN of the knee is hardly recognized. In a literature search, we only found five articles on total knee arthroplasty for Charcot joints (1–5). We did not find a single article dealing with alternative treatment options or the general clinical course of this disease. We started our study

"Why are you crying? You got what you wanted!": Psychosocial experiences of sex reassignment surgery

Little is known about the psychosocial needs of trans individuals as they make the surgical transition to their preferred gender. This qualitative study explored the lived experiences of 14 Australian trans men and women, aged between 25 and 78 who had undergone sex reassignment surgery to determine if their needs were met. The key findings suggest that while the surgery met their personal needs, there are inconsistencies in the level of care and support provided at the medical level throughout the transition process. In legal terms, the complex legislative framework does little but increase the psychosocial burden of Australian trans people.

Investigating the effect of Eye Movement Desensitization and Reprocessing (EMDR) on postoperative pain intensity in adolescents undergoing surgery: A randomized controlled trial

Aim To investigate the efficacy of Eye Movement Desensitization and Reprocessing for postoperative pain management in adolescents. Background Eye Movement Desensitization and Reprocessing is an inexpensive, non-pharmacological intervention that has successfully been used to treat chronic pain. It holds promise in the treatment of acute, postsurgical pain based on its purported effects on the brain and nervous system. Design A randomized controlled trial was used. Methods Fifty-six adolescent surgical patients aged between 12-18 years were allocated to gender-balanced Eye Movement Desensitization and Reprocessing (treatment) or non-Eye Movement Desensitization and Reprocessing (control) groups. Pain was measured using the Wong-Baker FACES® Pain Rating Scale (WBFS) before and after the intervention (or non-intervention for the control group). Findings A Wilcoxon signed-rank test demonstrated that the Eye Movement Desensitization and Reprocessing group experienced a significant reduction in pain intensity after treatment intervention, whereas the control group did not. Additionally, a Mann–Whitney U-test showed that, while there was no significant difference between the two groups at time 1, there was a significant difference in pain intensity between the two groups at time 2, with the Eye Movement Desensitization and Reprocessing group experiencing lower levels of pain. Conclusion These results suggest that Eye Movement Desensitization and Reprocessing may be an effective treatment modality for postoperative pain.