Provision of services for rehabilitation of children and adolescents with congenital cardiac disease: a survey of centres for paediatric cardiology in the United Kingdom

A postal questionnaire survey of the 17 centres for paediatric cardiology in the UK investigated the attitudes of staff towards rehabilitation and the current level of provision. The majority of respondents (82%) believed they should provide rehabilitation for their patients, but only one centre had a programme for rehabilitation. Few respondents (18%) believed they were meeting the needs of their patients' for rehabilitation. Major barriers to providing rehabilitation were funding and the wide geographical catchment areas

“Prehabilitation” prior to CABG surgery improves physical functioning and depression☆

AbstractBackgroundMany patients demonstrate psychological distress and reduced physical activity before coronary artery bypass graft surgery (CABG). Here we evaluated the addition of a brief, cognitive-behavioural intervention (the HeartOp Programme) to routine nurse counselling for people waiting for CABG surgery.MethodsRandomised controlled trial comparing nurse counselling with the HeartOp programme to routine nurse counselling in 204 patients awaiting first time elective CABG. Primary outcome measures were: anxiety and length of hospital stay; secondary outcome measures were: depression, physical functioning, cardiac misconceptions and cost utility. Measures were collected prior to randomisation and after 8 weeks of their intervention prior to surgery, excepting length of hospital stay which was collected after discharge following surgery.Results100 patients were randomised to intervention, 104 to control. At follow-up there were no differences in anxiety or length of hospital stay. There were significant differences in depression (difference=7.79, p=0.008, 95% CI=2.04–13.54), physical functioning (difference=0.82, p=0.001, 95%CI=0.34–1.3) and cardiac misconceptions (difference=2.56, p<0.001, 95%CI=1.64–3.48) in favour of the HeartOp Programme. The only difference to be maintained following surgery was in cardiac misconceptions. The HeartOp Programme was found to have an Incremental Cost Effectiveness Ratio (ICER) of £288.83 per Quality-Adjusted Life Year.ConclusionsNurse counselling with the HeartOp Programme reduces depression and cardiac misconceptions and improves physical functioning before bypass surgery significantly more than nurse counselling alone and meets the accepted criteria for cost efficacy

Internal and External Change Agents

A survey questionnaire was designed and distributed to samples of internal and external change agents which measured the extent to which they professed values traditionally associated with the field of OD. The survey also included questions concerning the types of interventions utilised in the change programmes that respondents had been associated with in the previous five years as well as how these programmes had been evaluated. As predicted, external change agents were more likely to profess traditional OD values and to be associated with change programmes which included human processual interventions. Contrary to expectations, internal change agents were less likely than external change agents to be associated with the utilisation of technostructural interventions. Support was also generated for the prediction that internal change agents are more likely to carry out extensive programme evaluations