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  • 1
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2011
    In:  Circulation: Cardiovascular Quality and Outcomes Vol. 4, No. suppl_2 ( 2011-11)
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 4, No. suppl_2 ( 2011-11)
    Abstract: Introduction: Prior research indicates underprescription of warfarin to reduce cardioembolism for eligible atrial fibrillation (AF) patients. Physicians' reluctance to prescribe warfarin for AF patients may be due to perceived increased risk of bleeding or underestimation of stroke risk. However, other factors may influence decisions for warfarin treatment. The purpose of the present study was to develop an in-depth understanding of the cardiologist's decision making process for warfarin anticoagulation and the management of AF. Methods: Qualitative in-depth interviews were conducted with 16 (14 male) cardiologists in a large Midwestern cardiology practice affiliated with an urban hospital. Interviews ranged from 15-35 minutes, culminating in nearly 200 pages of transcripts, and took place in person (n=6) at the hospital or over the telephone (n=10). On average, participants had 13 years of experience in treating patients and all had experience with AF patients who had excessive bleeds and/or strokes within the past 12 months. Interviews were conducted until thematic saturation occurred. Results: Descriptive content analysis found that cardiologists reported consideration of a range of clinical factors: rate and rhythm control, CHADS 2 score, patient co-morbidities, and other prescribed medications in their decision to aggressively treat according to accepted AF treatment guidelines. Additionally, their decision also considered more subjective factors such as the likelihood a patient would comply with a complex therapy and knowledge of patients' drug and alcohol use. “You have to risk profile them individually and go from there” was a recurrent observation. Conclusions: The decision making process used by cardiologists in determining warfarin anticoagulation in the treatment of AF is complex. The cardiologist considers a range of factors when prescribing warfarin beyond the clinical risks including more subjective lifestyle and cultural issues. When these other unmeasurable factors, such as the burden of treatment and lifestyle, are entered into the equation by cardiologists, anticoagulation may be less appealing, regardless of actual clinical risk.
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2011
    detail.hit.zdb_id: 2453882-6
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  • 2
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 2, No. 4 ( 2013-08-22)
    Abstract: Little is known about recovery of female sexual function following an acute myocardial infarction ( MI ). Interventions to improve sexual outcomes in women are limited. Methods and Results Semistructured, qualitative telephone interviews were conducted with 17 partnered women (aged 43 to 75 years) purposively selected from the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients’ Health Status Registry to deepen knowledge of recovery of female sexual function following an acute myocardial infarction ( MI ) and to improve sexual outcomes in women. Sixteen women had a monogamous relationship with a male spouse; 1 had a long‐term female partner. Most women resumed sexual activity within 4 weeks of their MI . Sexual problems and concerns were prevalent, including patient and/or partner fear of “causing another heart attack.” Few women received counseling about sexual concerns or the safety of returning to sex. Most women who discussed sex with a physician initiated the discussion themselves. Inquiry about strategies to improve sexual outcomes elicited key themes: need for privacy, patient‐centeredness, and information about the timing and safe resumption of sexual activity. In addition, respondents felt that counseling should be initiated by the treating cardiologist, who “knows whether your heart is safe,” and then reinforced by the care team throughout the rehabilitation period. Conclusions Partnered women commonly resume sexual activity soon after an MI with fear but without directed counseling from their physicians. Proactive attention to women's concerns related to sexual function and the safety of sexual activity following an MI could improve post‐ MI outcomes for women and their partners.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 2653953-6
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  • 3
    In: American Heart Journal, Elsevier BV, Vol. 178 ( 2016-08), p. 190-197
    Type of Medium: Online Resource
    ISSN: 0002-8703
    RVK:
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2016
    detail.hit.zdb_id: 2003210-9
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  • 4
    Online Resource
    Online Resource
    Oxford University Press (OUP) ; 2011
    In:  European Journal of Cardiovascular Nursing Vol. 10, No. 1 ( 2011-03), p. 50-55
    In: European Journal of Cardiovascular Nursing, Oxford University Press (OUP), Vol. 10, No. 1 ( 2011-03), p. 50-55
    Type of Medium: Online Resource
    ISSN: 1474-5151 , 1873-1953
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2011
    detail.hit.zdb_id: 2099328-6
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  • 5
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation: Cardiovascular Quality and Outcomes Vol. 8, No. 2_suppl_1 ( 2015-03)
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 8, No. 2_suppl_1 ( 2015-03)
    Abstract: Prompt recognition of acute myocardial infarction symptoms and timely care-seeking behavior are critical to optimize acute medical therapies. Relatively little is known about the symptom presentation and care-seeking experiences of women aged ≤55 years with acute myocardial infarction, a group shown to have increased mortality risk as compared with similarly aged men. Understanding symptom recognition and experiences engaging the healthcare system may provide opportunities to reduce delays and improve acute care for this population. Methods and Results— We conducted a qualitative study using in-depth interviews with 30 women (aged 30–55 years) hospitalized with acute myocardial infarction to explore their experiences with prodromal symptoms and their decision-making process to seek medical care. Five themes characterized their experiences: (1) prodromal symptoms varied substantially in both nature and duration; (2) they inaccurately assessed personal risk of heart disease and commonly attributed symptoms to noncardiac causes; (3) competing and conflicting priorities influenced decisions about seeking acute care; (4) the healthcare system was not consistently responsive to them, resulting in delays in workup and diagnosis; and (5) they did not routinely access primary care, including preventive care for heart disease. Conclusions— Participants did not accurately assess their cardiovascular risk, reported poor preventive health behaviors, and delayed seeking care for symptoms, suggesting that differences in both prevention and acute care may be contributing to young women’s elevated acute myocardial infarction mortality relative to men. Identifying factors that promote better cardiovascular knowledge, improved preventive health care, and prompt care-seeking behaviors represent important target for this population.
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 2453882-6
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  • 6
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2009
    In:  Journal of Cardiovascular Nursing Vol. 24, No. 5 ( 2009-09), p. 371-379
    In: Journal of Cardiovascular Nursing, Ovid Technologies (Wolters Kluwer Health), Vol. 24, No. 5 ( 2009-09), p. 371-379
    Type of Medium: Online Resource
    ISSN: 0889-4655
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2009
    detail.hit.zdb_id: 2053461-9
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  • 7
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2011
    In:  Circulation: Cardiovascular Quality and Outcomes Vol. 4, No. suppl_2 ( 2011-11)
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 4, No. suppl_2 ( 2011-11)
    Abstract: Objective: Describe sexual problems experienced by female patients following an MI to inform best practices for prevention and treatment. Methods: Women in the U.S. TRIUMPH MI registry who reported being sexually active before and 12 months after their MI were randomly selected. In-depth telephone interviews 18-24 months post-MI were conducted until thematic saturation occurred. Transcripts were coded and content analyzed by a multidisciplinary team including a nurse, psychologist, public health researcher, anthropologist, and gynecologist. Findings: Mean age was 58 years (range 43 to 75). Most subjects (13/17) said sexual activity was important before and after the MI. Although frequency of sexual activity was generally lower, the majority had resumed sexual activity by 6 months post-MI. Three women had resumed sexual activity within 3 weeks of the MI. Common, bothersome sexual problems after MI included: 1) low desire and arousal: “Since I had my heart attack the desire is not there anymore, not like it was. And I don't get the same feeling that I used to get from it.”, 2) vaginal dryness: “It's so bad. But I don't know what to do with that.” and 3) fear or worry that sex will trigger another MI: “My first experience, I was trying so hard, I had a real heart palpitation. You know, real strong and my heart beat real fast and it scared me.” Patients described their own and their partner's fear about sex as a hindrance: “I had to convince my husband that I wasn't going to die in bed.” Women indicated that physician-initiated attention to sexual concerns following an MI is lacking. Some attributed their sexual problems to medications that were initiated after the MI. Despite sexual problems experienced by MI patients and their partners, several women reported pleasure, physical closeness, normalcy, and “living life to the fullest” in the face of a life-threatening condition as motivations for continued sexual activity. Conclusions: Many women continue to be sexually active following an MI, in spite of bothersome sexual problems and worry about MI recurrence triggered by sex. Sexual activity, including fear of recurrent MI, should be addressed during post-MI care. These findings are being used to develop an intervention to improve sexual outcomes in women following MI.
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2011
    detail.hit.zdb_id: 2453882-6
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  • 8
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2011
    In:  Journal of Cardiovascular Nursing Vol. 26, No. 4 ( 2011-07), p. E12-E19
    In: Journal of Cardiovascular Nursing, Ovid Technologies (Wolters Kluwer Health), Vol. 26, No. 4 ( 2011-07), p. E12-E19
    Type of Medium: Online Resource
    ISSN: 0889-4655
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2011
    detail.hit.zdb_id: 2053461-9
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  • 9
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2011
    In:  Circulation: Cardiovascular Quality and Outcomes Vol. 4, No. suppl_2 ( 2011-11)
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 4, No. suppl_2 ( 2011-11)
    Abstract: Purpose: Post-MI recovery requires major life adjustments, which may include a person's sex life. MI educational materials contain information on medications and activities, but often neglect sexual activity. A qualitative study of sexuality with post-MI women sought to identify what information would be helpful. Methods: Women in the U.S. TRIUMPH MI registry who reported being sexually active before and 12 months after their MI were randomly selected. In-depth telephone interviews 18-24 months post-MI were conducted until thematic saturation occurred. Transcripts were coded and content analyzed by a multidisciplinary team of a nurse, psychologist, public health researcher, anthropologist, and gynecologist. Results: The 17 female subjects averaged 57.6 years of age (43-75 years). Twelve stated they had not received any information about sexual activity even though they felt sex was still an important aspect of their life. Three thematic categories emerged: initiating the discussion; criteria for readiness to resume sex; and education content. Several women mentioned that they were uncomfortable initiating the discussion of sex post-MI; a 48 y/o woman said, "I think definitely the doctor (cardiologist) has to initiate it because most women will not bring it up." The criteria for when to resume sex safely was not communicated clearly. Several women said that when they asked their physician and were told ‘when you feel like it,’ they remained fearful. One 49 y/o stated she got her information from a popular movie where "Jack Nicholson had a heart attack and the doctor told him that when he could walk up a flight of stairs, he could have sex. That’s kind of what I went by." The specific content for sexuality education was also missing. A 69 y/o described the lack of information: "I had cardiac rehab and there were lots of different classes I could go to. But there was nothing offered in the sexuality area. It was a missing link." Conclusions: Patients emphasized the importance of receiving guidance on timing and safety of resumption of sexual activity from their cardiologist, tailored to their specific cardiac condition and overall health. Initiating the discussion and providing information about sexual activity is an important opportunity for post-MI education.
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2011
    detail.hit.zdb_id: 2453882-6
    Location Call Number Limitation Availability
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  • 10
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2011
    In:  Circulation: Cardiovascular Quality and Outcomes Vol. 4, No. suppl_1 ( 2011-11)
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 4, No. suppl_1 ( 2011-11)
    Abstract: Background: Adherence to evidence-based therapies has emerged as a critical challenge in translating discoveries to clinical care. In particular, nonadherence to secondary prevention medications reduces the potential to optimize patients' outcomes. We conducted serial qualitative research studies to define relevant domains, from patients' perspectives, associated with discontinuing cardiac medications (clopidogrel or cholesterol lowering therapy) and developed a brief tool to identify myocardial infarction (MI) patients' risk of discontinuing medications. Methods: Using the Health Belief Model (HBM) as a theoretical framework, an interdisciplinary team (nurse, psychologist, anthropologist, and cardiologist) analyzed more than 50 in-depth patient interviews. Themes that emerged within and across patient interviews were used to derive assessment items. The items underwent several cycles of refinement and resulted in the 11-item MedDQ. This was then included in a 26-center registry of 〉 700 MI patients. Lastly, the MedDQ was evaluated as to feasibility of use with the healthcare system by 49 healthcare providers. Results: The HBM provided a good fit for the data and development of items that mapped to the four primary factors of the model (susceptibility, severity, barriers, and cues to action While psychometric analysis continues, the feasibility interviews with healthcare providers were very positive. They indicated that the tool was perceived to be an important mechanism for systematically discussing medication issues with patients, could be adapted for a range of clinical settings, and provided valuable information that the providers could use to identify specific intervention needs. Conclusions: Hundreds of pages of narrative data, rich with cardiac patient's perspectives of medication discontinuance were reduced to a parsimonious survey. Feasibility interviews with healthcare providers indicated that the MedDQ can be easily administered to cardiac patients and could serve as an important source of information to guide supportive interventions. This creates an extraordinary opportunity for secondary prevention for cardiac patients. Formal testing of the impact of the MedDQ on patients' adherence to medications is needed.
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2011
    detail.hit.zdb_id: 2453882-6
    Location Call Number Limitation Availability
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