Zoekresultaten

Barriers that obstruct return to work after coronary bypass surgery: a qualitative study

Coronary artery bypass grafting is the most frequently performed cardiac surgical procedure. Despite its benefits on survival and quality of life, it is associated with a considerable financial burden on society including sick leave. Our study aimed to explore the barriers that obstruct return to work after coronary artery bypass grafting. We performed a qualitative study with in-depth interviewing of patients 6 months after their surgery. We included ten working patients and interviewed them and their spouses at home. The interviews were transcribed and two investigators independently searched the transcriptions for barriers that had obstructed return to work. Based on the interviews we were able to distinguish four main groups of barriers: 'personal', 'healthcare', 'work' and 'law & regulation.' The personal barriers were subgrouped in affective, physical, cognitive, social and individually determined factors. Conclusion In a qualitative study we showed that personal barriers as well as barriers regarding healthcare, work and law & regulation, were perceived by patients as important factors obstructing return to work after coronary artery bypass grafting. To overcome the identified barriers, the process of return to work could preferably be initiated during the hospital phase, started during cardiac rehabilitation, and coordinated by a case-managing professional.

Handreiking hitte in bestaande woningen 3.0

Heat shock protein-inducing compounds as therapeutics to restore proteostasis in atrial fibrillation

Atrial fibrillation (AF) is the most common clinical tachyarrhythmia associated with significant morbidity and mortality and is expected to affect approximately 30 million North Americans and Europeans by 2050. AF is a persistent disease, caused by progressive, often age-related, derailment of proteostasis resulting in structural remodeling of the atrial cardiomyocytes. It has been widely acknowledged that the progressive nature of the disease hampers the effective functional conversion to sinus rhythm in patients and explains the limited effect of current drug therapies. Therefore, research is directed at preventing new-onset AF by limiting the development of substrates underlying AF promotion. Upstream therapy refers to the use of drugs that modify the atrial substrate- or target-specific mechanisms of AF, with the ultimate aim to prevent the occurrence (primary prevention) and recurrence of the arrhythmia following (spontaneous) conversion and to prevent the progression of AF (secondary prevention). Recently, we observed that heat shock protein (HSP)-inducing drugs, such as geranylgeranylacetone, prevent derailment of proteostasis and remodeling of cardiomyocytes and thereby attenuate the AF substrate in cellular, Drosophila melanogaster, and animal experimental models. Also, correlative data from human studies were consistent with a protective role of HSPs in preventing the progression from paroxysmal AF to permanent AF and in the recurrence of AF. In this review, we discuss novel HSP-inducing compounds as emerging therapeutics for the primary and secondary prevention of AF. © 2012 Elsevier Inc.

BEHANDELADVIES POST-COVID-19

INLEIDING In deze module worden behandeladviezen gegeven voor de Post-COVID-19 ambulante behandeling in de geriatrische revalidatie gericht op somatische-, functionele- en psychische status. Deze module is een onderdeel van het behandeladvies post-COVID-19 (geriatrische) revalidatie-Verenso. Deze module is in een zeer korte tijd tot stand gekomen en heeft de status van groeidocument. Zorgvuldigheid is betracht om zowel de (beperkte) ervaringskennis, als de actuele stand van de wetenschappelijke literatuur hierin te betrekken. Voor dit behandeladvies is gebruik gemaakt van het door GRZPLUS ontwikkeld ambulant revalidatieprogramma CO FIT+. Bij GRZPLUS is een doorontwikkeling gemaakt op basis van de update behandeladvies post-COVID-19 geriatrische revalidatie van Verenso (Verenso, 19-05-2020) welke is gebaseerd op de principes van longrevalidatie zoals vertaald in het Behandelprogramma geriatrische COPD-revalidatie (van Damvan Isselt et al.) en het Behandelprogramma COVID-19 Post IC, van Revalidatiecentrum de Hoogstraat (Brouwers, de Graaf). Dit is aangevuld met behandeladviezen en leidraden vanuit de beroepsverenigingen en kennis uit wetenschappelijk onderzoek (long-revalidatie) en vanuit het REACH netwerk (REhabilitation After Critical illness and Hospital discharge). De komende maanden zullen zowel de nieuwe wetenschappelijke literatuur als de ervaringen uit de praktijk gebruikt worden om de handreiking te verbeteren en zo nodig aan te vullen. Dat zullen wij doen met specialisten ouderengeneeskunde, revalidatieartsen, klinisch-geriaters, paramedici, longartsen, verpleegkundigen, infectie deskundigen, en andere betrokken beroepsgroepen. De revalidatie van ambulante post-COVID-19 patiënten vereist vooral afstemming binnen de multidisciplinaire zorg. De complexiteit en ernst van de problematiek en de interactie van beperkingen op diverse domeinen maakt dat interdisciplinaire behandeling essentieel is.

Screening of novel HSP-inducing compounds to conserve cardiomyocyte function in experimental atrial fibrillation

Background: The heat shock protein (HSP) inducer, geranylgeranylacetone (GGA), was previously found to protect against atrial fibrillation (AF) remodeling in experimental model systems. Clinical application of GGA in AF is limited, due to low systemic concentrations owing to the hydrophobic character of GGA.Objectives: To identify novel HSP-inducing compounds, with improved physicochemical properties, that prevent contractile dysfunction in experimental model systems for AF.

Are grown-ups with congenital heart disease willing to participate in an exercise program?

OBJECTIVE: To examine the willingness of grown-ups with congenital heart disease (GUCH) to participate in the GUCH Training Program-Individualised (GTI), an exercise program specifically designed for GUCH, and to identify factors affecting their willingness to participate.In this cross-sectional study, all outpatient GUCH of the University Medical Center Groningen in The Netherlands, living within a 30-km radius of Groningen (n = 311), were asked to participate.In total, 116 (37%) of the 311 GUCH who are invited to participate in our study returned completed questionnaires. The median age of the respondents was 40 (interquartile range 31-50) years and 55% were women.Respondents (n = 116) completed a questionnaire that queried physical activity, perceived physical fitness, psychosocial determinants (motivation, self-efficacy, and social support) related to physical activity, and willingness to participate in GTI.Of the 116 respondents, 68 (59%) were willing to participate in GTI. They were less physically active, had worse perceived physical fitness, were less satisfied with their fitness, were generally more motivated to engage in physical activity, and had more social support than patients unwilling to participate. The best logistic regression model predicting willingness to participate in GTI included the variables perceived physical fitness and motivation for physical activity in general.CONCLUSIONS: Asking GUCH to participate in an exercise program supervised by physical therapists is a good strategy. Taken into account nonresponse, a participation rate in the exercise program of over 20% is to be expected. Perceived physical fitness and motivation for physical activity in general are important predictors of patients' willingness to participate