Silent myocardial ischemia: is the person or the event silent?

Article Abstract:

Signs of disease and patients' reports regarding disease severity are known to be poorly correlated, often reflecting more about their beliefs about disease than the actual severity of the medical problem. This may be true of people who suffer from arthritis, peptic ulcer, asthma, and heart disease. As many as one-third of the people with severe chest pain of the type associated with ischemic heart disease (insufficient blood supply to the heart itself via the coronary arteries) do not have coronary artery disease severe enough to explain this pain, while 'silent' ischemia is characterized by cardiac abnormalities without symptoms. How important are psychological and social variables in determining the ways that certain symptoms of myocardial ischemia are perceived or described by the patient? A review is provided of knowledge regarding this topic. These facts lead to underdiagnosis of coronary artery disease, as well as to treatment delays. While pain generally increases with the duration and severity of ischemia, it is also affected by the location and specific physiological cause (decreased oxygen supply versus increased demand) of the ischemic event. The pathophysiology of cardiac pain, a subject about which little is known, is discussed briefly. The patient's experience of pain is the result of perceptual sensitivity; the extent to which symptoms are denied (ignored because they would generate unbearable fear or distress); and the intellectual assessment of what the situation means. These factors are described in detail. Understanding the ways symptoms may be suppressed or magnified is important for accurate diagnosis of myocardial ischemia. Treatment outcomes, too, may be improved by helping patients become aware of the ways they mask or exaggerate their own sensations of pain and discomfort. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Diagnosis, Physiological aspects, Development and progression, Chest pain, Silent myocardial ischemia

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Length of stay in the intensive care unit: effects of practice guidelines and feedback

Article Abstract:

Approximately 20 percent of hospital patients use intensive care units (ICUs), but the benefits of these expensive hospital units for all of the patients who use them are largely unproven. Many studies have shown that the reasons for admission to these units are often precautionary, and the facilities and various possible interventions that are provided by ICUs are usually not used. It is important for clinicians to better utilize ICUs to minimize cost, while protecting the patients' health. The present study reports on the development of management guidelines for the admission of patients to ICUs. During this process, 1,145 consecutive admissions to the ICU were studied. Integral to the guidelines was the development of a system of feedback of information to the participating physician. As a result of implementing the policy, the length of hospital stays fell from an average of 8.43 to 7.41 days, and ICU stays also declined from an average of 2.45 to 2.07 days. Six-month follow-up showed that mortality and readmission rates were unchanged after the development of the guidelines. The development and use of clinical practice guidelines also helped to clarify local practice patterns. The results show that patient care was not adversely effected, while the attendant costs of ICU use were lowered when these units were used less frequently. Also, more patients felt that the length of their hospital stay was 'just right', and fewer patients thought that their hospital stay was 'too long'. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hospitals, Medical care, Quality management, Medical care quality, Intensive care units

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Cognitive behavior therapy for hypochondriasis: A randomized controlled trial

Article Abstract:

Hypochondriasis is a situation where a person feels that he is suffering from a serious illness, which is not diagnosed. Cognitive behavior therapy is considered as a solution to this problem that involves treatment sessions in the psychiatry department and a few of these sessions, which are randomly assessed, have given good results.

United States, Care and treatment, Dosage and administration, Cognitive therapy, Hypochondria, Hypochondriasis

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