Research Corner The ultimate goal ...

Research Corner

The ultimate goal of evidence-based practice is to synthesize available data from various sources in order to make a clinical decision. After formulating a clinical question, searching literature databases, and evaluating research articles individually a consensus of the evidence must be bring outed In some instances a clinical decision can be made with an certainty whereas sometimes a reasonable hypothesis can be generated. Many times there is insufficient data to base a decision onward the evidence, in which case a gap in knowledge has been identified. Sometimes the paucity of information can be augmented with data generated from clinical practice situations. Clinical preliminary data collection can take many forms, like as reviewing patient charts, summarizing a patient case, or collecting pilot data. The design of this article is to quick in emergencies an example of the culminating proces of evidence-based practice.

The clinical guiding question used in this example is, "Would additional rehabilitation services improve the functional status of patients recovering acutely from coronary artery bypass (CAB) surgery?" The first degree in answering this question is to determine to what degree functional status has been measured in previous studies. nearest determining if functional status is impaired acutely following CAB surgery is crucial. If impaired functional status has been established, then the efficacy of specific rehabilitation interventions warrants investigation. As the proces of reviewing and synthesizing the available research literature progresse gaps in knowledge will indicate the ne for preliminary clinical data. Clinical data generation and analysis adds to the existing information and progresse the proces of evidenced-based practice closer to answering the pos clinical guiding question.

LITERATURE REVIEW

Functional Status following CAB Surgery

Functional status, as assessed by way of measurements of health-related quality of life, point outs improvements at 6, 12, and 24 month following CAB surgery1-4 level older patients (> 80 years of age) maintain health-related quality of life 1 to 2 years after cardiac surgery when compared to their cohort age group3 hardly any studies have examined healthrelated quality of life postoperatively within the first 3 month or after 5 years in patients that have undergone cardiac surgery Westin et a 16 measured psychological and somatic domains of quality of life in patients 1 month and 1 year after acute myocardial infarction, CAB surgery or percutaneous transluminal cardiac angioplasty. They originate that patients with cardiac enigmas differed from controls in the pair psychological and somatic aspects of quality of life at 1 month and somatic aspects of quality of life at 1 year follow-up6 At 5 years following CAB surgery Herlitz et al documented an inverse relationship between age and functional improvements.7 Therefore, the evidence indicates that patient quality of life is improved on I year following CAB surgery on the contrary prior to this may still he impaired.

Qualitative research evaluating patients status post-CAB surgery remind ofs that many surgery specific factors interfere with patient function. Edell-Gustafsson and colleagues' interviewed patients before and 3 month after CAB surgery and rest that patients reported incisional (sternotomy and donor graft leg) pain and drainage that persisted 1 month after CAB surgery Patients in this subject of attention also complained of continuous pain from the shoulders and neck respiratory puzzles feelings of weakness, and sleeping difficulties including chest wall pain with sidelying, waking as a common thing [i]or[/i] matter and early, and more nightmares than usual.8 Anderson et al used patient interviews 1 year following CAB surgery and identified the most numerous important patient concerns as point to be solved [i]or[/i] settleds with wound healing, thoracic pain, and dissatisfaction with postoperative supportive care.9 Other studies have set up discomfort at chest and leg incisions; shortness of breath; puzzles with eating; difficulty with sleeping, pain in the shoulders, back, and neck; ineffective coping, and medication side tenors as frequently reported symptoms in patients following CAB surgery"" Qualitative data indicate that patients experience many negative symptoms that may affect their functional status following CAB surgery

Although an inherently important aspect of functional status, activities of daily living (ADL) performance has not been consistently or not rarely reported as an outcome measure in patients following CAB surgery common study reported that following CAB surgery almost all somewhat old women were able to perform basic self-care tasks.12 Kimble studied women with coronary artery disease and their perceived ability to perform household activities, and plant that the women believed that their cardiac symptoms interfered with their functional abilities.11 Redeker et al measured women's of the same height of activity over 6 month following CAB surgery and raise increases in activity level as measured by the agency of accelerometer.14 Stewart et al establish that while women typically functioned at a lower horizontal than men prior to the surgery the two improved in activity level similarly after CAB surgery45 The impact of CAB surgery upon sexual function prior to, 3 month and 2 years postsurgery also has been studied and findings recommend that men improved more than women overall in sexual function." Activity on a level as assessed with the Functional Status Questionnaire, at 1 6 and 12 month after CAB surgery displays improvements after 6 months 17 18Thus, it appears that daily activity even continues to improve over the first 6 month following CAB surgery