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Long-term psychological consequences of symptomatic pulmonary embolism: a qualitative study.

ABSTRACT: To explore the psychological consequences of experiencing symptomatic pulmonary embolism (PE).Qualitative interview-based study using interpretative phenomenological analysis.Outpatients who attended an anticoagulation clinic in a district general hospital.Patients attending an anticoagulation clinic following hospital admission for symptomatic PE were approached to participate. A total of 9 (4 women, 5 men) of 11 patients approached agreed to be interviewed. Participants were aged between 26 and 72 years and had previously experienced a PE between 9 and 60 months (median=26 months, mean=24 months).Audiotaped semistructured qualitative interviews were undertaken to explore participants experiences of having a PE and how it had affected their lives since. Data were transcribed and analysed using interpretative phenomenological analysis to identify emergent themes.Three major themes with associated subthemes were identified. Participants described having a PE as a life-changing experience comprising initial shock, followed by feeling of loss of self, life-changing decisions and behaviour modification. Features of post-traumatic stress disorder (PTSD) were described with flashbacks, hypervigilance and intrusive thoughts being most prevalent. Participants identified several areas of support needed for such patients including easier access to support through information giving and emotional support.Long-term consequences of venous thromboembolism go beyond the physical alone. Patients describe experiencing symptomatic PE to be a life-changing distressing event leading to behaviour modification and in some PTSD. It is likely that earlier psychological intervention may reduce such long-term sequelae.

SUBMITTER: Noble S

PROVIDER: S-EPMC3987719 | biostudies-literature | 2014 Apr

REPOSITORIES: biostudies-literature

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Long-term psychological consequences of symptomatic pulmonary embolism: a qualitative study.

Noble Simon S Lewis Rhian R Whithers Jodie J Lewis Sarah S Bennett Paul P

BMJ open 20140402 4

<h4>Objective</h4>To explore the psychological consequences of experiencing symptomatic pulmonary embolism (PE).<h4>Design</h4>Qualitative interview-based study using interpretative phenomenological analysis.<h4>Setting</h4>Outpatients who attended an anticoagulation clinic in a district general hospital.<h4>Participants</h4>Patients attending an anticoagulation clinic following hospital admission for symptomatic PE were approached to participate. A total of 9 (4 women, 5 men) of 11 patients app ...[more]

PMID: 24694625

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Project description:Objectives:Acute pulmonary embolism can be a life-threatening condition with a high mortality. The treatment choice is a matter of debate. The early and late outcomes of patients treated with surgical pulmonary embolectomy for acute pulmonary embolism in a single center were analyzed. Methods:All consecutive patients operated on for pulmonary embolism between January 2002 and March 2017 were reviewed. Patient demographics and pre- and postoperative clinical data were retrieved from our patient registry, and risk factors for in-hospital and long-term mortality were identified. Results:In total, 175 patients (mean age 59±3 years, 50% male) were operated on for acute pulmonary embolism. In-hospital mortality was 19% (34/175). No differences were found when comparing surgery utilizing a beating heart or cardioplegic arrest. Risk factors for in-hospital mortality were age >70 years [odds ratio (OR) 4.8, confidence interval (CI) 1.7-13.1, p=0.002], body surface area <2 m2 (OR 4.7, CI 1.6-13.7, p=0.004), preoperative resuscitation (OR 14.1, CI 4.9-40.8, p<0.001), and the absence of deep vein thrombosis (OR 9.6, CI 2.5-37.6, p<0.001). Follow-up was 100% complete with a 10-year survival rate of 66.4% in 141/175 patients surviving to discharge. Once discharged from hospital, none of the risk factors identified for in-hospital mortality were relevant for long-term survival except the absence of deep vein thrombosis (OR 3.2, CI 1.2-8.2, p=0.019). The presence of malignancy was a relevant risk factor for long-term mortality (OR 4.3, CI 1.8-10.3, p=0.001). Conclusion:Surgical pulmonary embolectomy as a therapy for acute pulmonary embolism demonstrates excellent short- and long-term results in patients with an otherwise life-threatening disease, especially in younger patients with a body surface area >2 m2 and pulmonary embolism caused by deep vein thrombosis. Pulmonary embolectomy should therefore not be reserved as a treatment of last resort for clinically desperate circumstances.

Project description:ObjectivesTo develop a more specific understanding of psychological mechanisms in the development of burnout in long-term care as a basis for potential new intervention strategies aiming at improving nurses' mental health.MethodsTwo qualitative studies with thematic analysis were conducted. In Study 1, we conducted eight group interviews with 110 nurses from May-July 2019 in the context of workshops at eight nursing homes in Germany. In Study 2, we supplemented these with semi-structured interviews with 14 executives at German nursing homes in December 2019.ResultsThe thematic analysis in Study 1 identified three main themes: causes of challenges, employees' opportunities for change, and organisational opportunities for change. Thematic analysis in Study 2 identified three main themes: job motives, reasons for filling in for others, and employee self-care. Further, our results show that the need to stand in for colleagues, in particular, is one of the greatest challenges for geriatric caregivers. In dealing with these challenges we found that self-endangering behaviour-a diminished ability to say no when asked to fill in or to do work overtime-was an important antecedent of nurses' burnout. Further, high levels of altruistic motivation and identification with the team or organisation were associated with self-endangering behaviour in the presence of adverse working conditions. Low levels of self-worth are a further risk factor for self-endangering.ConclusionsOur findings are at odds with some core tenets of classic models of job demands and burnout that construe motivation and identification as resources. Our results show the need of a holistic intervention program in nursing including individual coaching, team-based interventions and organisational development processes. Employees themselves should be sensitized to this issue and supported in the long term, and politicians should create structures that do not encourage this behaviour any further.

Project description:ObjectivesCoronavirus disease 2019 (COVID-19) survivors are reporting residual abnormalities after discharge from hospital. Limited information is available about this stage of recovery or the lingering effects of the virus on pulmonary function and inflammation. This study aimed to describe lung function in patients recovering from COVID-19 hospitalization and to identify biomarkers in serum and induced sputum samples from these patients.MethodsPatients admitted to Spanish hospitals with laboratory-confirmed COVID-19 infection by a real-time PCR (RT-PCR) assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were recruited for this study. Each hospital screened their lists of discharged patients at least 45 days after symptom onset. SARS-CoV-2-infected patients were divided into mild/moderate and severe disease groups according to the severity of their symptoms during hospitalization. Patients' epidemiological and medical histories, comorbidities, chronic treatments, and laboratory parameters were evaluated. Pulmonary function tests, the standardized 6-minute walk test (6MWT) and chest computed tomography (CT) were also performed. The levels of proteases, their inhibitors, and shed receptors were measured in serum and induced sputum samples.ResultsA total of 100 patients with respiratory function tests were included in this study. The median number of days after the onset of symptoms was 104 (IQR 89.25, 126.75). COVID-19 was severe in 47% of patients (47/100). CT was normal in 48% of patients (48/100). Lung function was normal forced expiratory volume in one second (FEV1) ≥80%, forced vital capacity (FVC) ≥80%, FEV1/FVC ≥0.7, and diffusing capacity for carbon monoxide (DLCO) ≥80% in 92% (92/100), 94% (94/100), 100% (100/100) and 48% (48/100) of patients, respectively. Multivariate analysis showed that a DLCO <80% (OR 5.92; 95%CI 2.28-15.37; p < 0.0001) and a lower serum lactate dehydrogenase level (OR 0.98; 95%CI 0.97-0.99) were associated with the severe disease group of SARS-CoV-2 cases during hospital stay.ConclusionsA diffusion deficit (DLCO <80%) was still present after hospital discharge and was associated with the most severe SARS-CoV-2 cases.

Dataset Information

Long-term psychological consequences of symptomatic pulmonary embolism: a qualitative study.

Publications

Long-term psychological consequences of symptomatic pulmonary embolism: a qualitative study.

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