Effects of Rehabilitation on Post CABG Patients to Treat Anxiety and Depression
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This article discusses the impacts of rehabilitation over the post CABG having depression and anxiety. It includes rationale for exclusion of articles, summary of critical appraisal, applications to practice, and conclusion.
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Table of Content. PRISMA DIAGRAM.......................................................................................................................1 RATIONALE FOR EXCLUSION OF ARTICLES........................................................................1 SUMMARY OF CRITICAL APPRAISAL....................................................................................1 APPLICATIONS TO PRACTICE..................................................................................................1 CONCLUSION................................................................................................................................1 REFERENCES................................................................................................................................2
PRISMA DIAGRAM ENROLLMENT ALLOCATION FOLLOW-UP ANALYSIS Participations (n=80) Excluded participants (n= 70) randomized (n=10) allocated to intervention (n=5) lost to follow-up (n=3) effectively analysed (n=2)
RATIONALE FOR EXCLUSION OF ARTICLES The rationale of the research is well articulated as well as provided with the context of both professional and the personal enhancement. The research is mainly conducted to simply know about the impacts of rehabilitation over the post CABG having depression and anxiety. The article has been selected through accessing the sites such as springer nature, PubMed and various other. In the research, there are chosen articles that can help to gain knowledge about the topic which is effects of rehabilitation on the post CABG patients to treat anxiety and depression among them(Bianchi and et.al, 2018).In addition to this, apart from the chosen research article, there are some exclusion of research articles which involve the information about impacts of depression and anxiety after the cardiac events(Melnyk and et.al, 2018).The rationale for exclusion of the article is that it can provide information about the impacts of anxiety and depression on the cardiac events but not the rehabilitation effects on post CABG patients. To develop the research, there is taken the number of participants which receives the sessions of rehabilitation after the surgery of CABG. In this, there has been conducted a survey of about 66 participants who are receiving the sessions of cardiac rehabilitation programs to improve their well-being by reducing the effects of anxiety and depression among them (Aggarwal et. al., 2021). SUMMARY OF CRITICAL APPRAISAL The disorders of heart are generally the most common cause of mortality across world, as well as the coronary artery illness is particularly the most common among all the heart disorders. The CAD are mainly accounted for about 50% of deaths in the evolved countries as well as every year multiple people can die only due to absence of the care treatment present or can suffer from cardiac associated chronic disabilities(Shayan, Kiwanuka and Nakaye, 2019).It is identified by the article that about 40% of the males and about 20% of the females within whole population can suffer from cardiac arrest. Furthermore, the well-being care costs and the costs of the medication, rehabilitation, specific equipment’s all are estimated to be over 62 billion dollars. The heart disorders can cause an arterial stenosis, can compromise with the blood circulation to the myocardium as well as can lead to an ischaemia and the cardiac arrest just because of the build-up of an unnatural lipid, fibre and fat within the walls of blood vessels. As per the chosen research article, the care treatment methods for the coronary artery illness can specifically
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involve an angioplasty, stenting, the effective drug therapies as well as the surgical care treatments like the CABG (Coronary Artery Bypass Graft) surgery. It is determined by the study that the CABG care treatment can always remain the first preference of the patients who are having critical conditions linked with cardiac disorders since the drug therapy is generally not useful without the follow-up in the cardiac rehabilitation and the cardiac rehabilitation is mainly considered as a secondary care treatment prevention as well as can play an essential part among all the non-pharmacological interventions. The CABG is generally a traumatic event which can cause the depression and anxiety for the patients. While doing the study, the author has conducted the survey of the 80 patients having Coronary Artery Bypass Grafting and the number has been reduced after the eight weeks of the cardiac rehabilitation. However, one of the main aim of the care professionals is to effectively improves the comfort and decreases the stress of the vulnerable patients who are gone through CABG surgery(Santoftand et.al, 2019).In this, the heart rehabilitation is generally a group as well as an interdisciplinary care intervention which are specifically aimed at decreasing the developing risk of further heart events as well as its linked conditions via a person and a group training as well as the physical activities. It is identified that the rehabilitation procedure is mainly used to improve the quality of life of the patients and supports them to return to the work as well as their earlier life style. The rehabilitation procedure can also aid the Post CABG patients to effectively enhance their mental as well as the social conditions and can prevent the future heart associated complications among people. The rehabilitation can define all the aspects which are mainly used to aid the people having heart illness return to an active as well as a satisfying life in order to prevent the recurrence of the specific cardiac events. In addition to this, the services of the cardiac rehabilitation can contain the three types or stages such as inpatient, outpatient, as well as ongoing prevention. An inpatient rehabilitation can begin as soon as possible after the admission to the healthcare and the outpatient rehabilitation is generally the after discharge of the patients fromthehealthcareandanongoingpreventionapproachescaninvolvemaintainingthe vulnerable patient's long term cardiovascular stability and the physical conditions as well (The effect of cardiac rehabilitation on anxiety and depression in patients undergoing cardiac bypass graft surgery in Iran, 2012). Inthis,theinformationismainlygatheredbyusingademographicinformation questionnaire, the Beck's depression Inventory and Spielberg's two-part anxiety scale. In the
study, the Spielberg's anxiety scale is usually used to identify the state as well as the trait anxiety. In this, the scale involves about 40 questions and the score ranged from 40 points with no anxiety to a maximum of the 160 points. In addition to this, the first part of this two-part questionnaire can involve about 20 questions mainly concentrating over the anxiety conditions whereas, the second part can specifically include about 20 questions mainly concentrating over the trait anxiety. In this, each response is generally scored within 1 to 4 and the other total scores for every section such as state and trait are among 20 to 80. having score between 20 to 40 can show a mild anxiety, the score range between 41 to 60 express the moderate anxiety and above till 80 can depict critical anxiety conditions. Therefore, the reported the reliability and validity of the questionnaire.Inthis,theBeck'sdepressionInventoryisgenerallyusedthescreening instruments for the depression among the public. In addition to this, the self-questionnaire is mainly used to evaluate the anxiety and depression levels among the Post CABG patients and to determine the anxiety and depression levels in other people as well (Boreskie et. al., 2019). APPLICATIONS TO PRACTICE The randomised controlledtrails, meta-analysis and a systematic reviewhas been conducted on the cardiac rehabilitation programs, some of them are effectively decreased the mortality rates, enhanced quality of life and readmission within healthcare as well as an enhancement of the cardiac associated parameters which is the overall cholesterol. The self- reporting estimates of depression and anxiety are variable. Having anxiety is mainly high for the post CABG patients and to reduce the impacts of this, there are the rehabilitation programs. Most of the patients have fear of dying before instead of during the procedure has been depicted as an anxious and a pervasive preoccupation. The anxiety disorders can effectively manifest as an autonomic symptom which can further exacerbate the symptoms of Coronary artery bypass graft. After having the procedure, the anxiety levels can be reduced to the below operative levels, the critical of the anxiety does not remit to below the sub-clinical levels as well as can specifically sanctiontheeffectiveinterventions.Unlikedepression,anaccurateandcomplicating identification of an anxious patients over the course of surgery recovery is the finding that an autonomic-arousal symptom specifically enhances after the procedure of CABG. It is generally surprising given the overlap as well as apparently identical characteristics of the coronary artery disorder as well as a somatic anxiety symptom such as enhanced heart rates and breathlessness. In this, the very common anxiety illness generally appears to be GAD (general anxiety disorder),
an illness generally marked by the pervasive worry as well as a panic disorder, mainly exhibited by the recurrent panic attacks. While doing survey, it is found that there has been a voluntary written informed consent that was obtained from every patient who are participated. The professionalsgenerallyinterviewedallthepatientsinordertocollectthedemographic information’s as well as effectively completed the BAI (Beck Anxiety Inventory) as well as BDI- II (Beck Depression Inventory-II) questionnaires before initiation of the cardiac rehabilitation programs. An early and effective intervention to enhance the psychological illness, besides the traditional coronary risk components is greatly stressed in the current years. As exhibited in the research, having an eight weeks course cardiac rehabilitation programs consisting both the exercise trainings as well as the educational programs can specifically decreases the depression and anxiety levels among patients after CABG. The decrease of mortality within the depressed patients after myocardial infarction is greatly attained by an effective care treatment of the depression. Therefore, there are the various healing care methods for the enhancement of the psychological illness among patients having cardiac illness are proposed. In the study, the efficacy of the antidepressants as well as the psychotherapies within the decrease of specific depressive symptoms is compared with the cardiac rehabilitation programs. The outcomes generally revealed that the cardiac rehabilitation programs are superior to the antidepressants as well as the psychotherapies for overall decreasing the total mortality risks as well. It is identified by the study that mild enhancements within the levels of fitness after the cardiac rehabilitation were mainly linked with the decrease in the depressive symptoms as well as the excess mortality accompanying these such symptoms. In the study, a supervised exercise-based training can accompany the other elements of the cardiac rehabilitation programs and was specifically used to evaluate the results as well as determined that the enhancements within the mental health was specific (Laukkanen et. al., 2018). The cardiac rehabilitation has been delivered to the patients having acute coronary syndrome after the percutaneous coronary interventions as well as CABG can decreases the cardiovascularmortalitybyapproximately20to30%.Acrossglobal,theWorldhealth organization plan an effective action for preventing as well as controlling the prevalence of non- communicable illness. It is known that the burden of the cardiac disorders has been enhanced across nation more significantly in the last 10 years, both the primary and secondary prevention
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can play an essential part in reducing the incidences of the cardiovascular disorders as well as can effectively preventing their further complications. It is being determined that the uptake of the cardiac rehabilitation is moderate within the country. In addition to this, there are various effective strategies specifically carried out by the healthcare administrations such as the multiple cardiac projects, to effectively facilitate as well as enhances the adherence and participation within the cardiac rehabilitation programs. Therefore, there are some of the effective strategies that is being used to enhance the participation of the patients within the cardiac rehabilitation programs to reduce the anxiety and depression among patients. In addition to this, cardiac rehabilitation programs within the country is mainly run by the physical therapists along with the healthcare professionals, dietitians as well as the care nurses. For having an effective execution of the cardiac rehabilitation programs, a dedicated the cardiac rehabilitation department is a major requirement as it required a skilled multidisciplinary care team to run such effective program where the role of all the team members is quite essential (Beckie, 2019). CONCLUSION From the above research, it has been concluded that there are approximately about 30% - 40% of the total patients undergone CABG procedure and have been reported psychological side effects like anxiety, PTSD and depression. These side effects not only affect the social behaviour of the patient but even have indirect effects on the recovery rate of such patients resulting in higher mortality rates over time(Caliskan and et.al, 2020).Therefore, there has been increased focus on early identification of anxiety and depression in such patients so that their ill effects can be minimised to the least possible. Making the patient follow the self-reporting measures released by the American Heart Association and making a depression screening follow up routine mandatory in CABG patients can prove helpful in early identification. Although studies show that patients showing psychological side effects usually self-recover in a span of six months. But some require professional assistance in recovering(Hoyler and et.al, 2020).Talk therapy, Meditation, medication can be of a good aid to people help recover from psychological symptoms. Studies and randomised trials even support cardiac rehabilitation as a measure for reducing the cases of anxiety and depression. Patients undergoing cardiac rehabilitation after the surgery not only has shown reduced recurrence of cardiac problems but have also shown better results in helping patients to deal with psychological symptoms. Cardiac rehabilitation of all the three types namely Inpatient, Outpatient and Ongoing prevention aim at helping the cardiac
patients to bring back their quality of life as it was before the treatment with as minimised recurring cardiac events as possible. Usually the cardiac rehab program had stress- management modules incorporated for psychological symptoms but then trials revealed that adding Cognitive behaviour therapy to the program had benefactor effects on the management of stress by the patients. In the study, a 50-60-minute session was scheduled for the cardiac patients with clinical psychologists trained in CBT and for severe depression cases twice a week sessions were allowed along with weekly supervisions by an investigator (Tüfekçi, Akansel and Sivrikaya, 2022).From the research, it is identified that the cardiac rehabilitation is mainly recognized as an integral element of the patient care with the heart illness as an enhancing evidence on the cardiac rehabilitation and had proved that the cardiac rehabilitation program services are generally the lifesaving as well as underutilized. In this, there is a high requirement to revisit the cardiac rehabilitationdeliveryprotocolsandthespreadtheawarenessamongthehealthcare professionals and its linked stakeholders, consisting the heart patients to enhance the uptake of the cardiac rehabilitation programs.
REFERENCES Books and Journals: Aggarwal, M., Ornish, D., Josephson, R., Brown, T.M., Ostfeld, R.J., Gordon, N., Madan, S., Allen, K., Khetan, A., Mahmoud, A. and Freeman, A.M., 2021. Closing gaps in lifestyle adherence for secondary prevention of coronary heart disease.The American Journal of Cardiology,145, pp.1-11. Beckie, T.M., 2019. Utility of home-based cardiac rehabilitation for older adults.Clinics in geriatric medicine,35(4), pp.499-516. Boreskie, K.F., Hay, J.L., Kehler, D.S., Johnston, N.M., Rose, A.V., Oldfield, C.J., Kumar, K., Toleva, O., Arora, R.C. and Duhamel, T.A., 2019. Prehabilitation: the right medicine for older frail adults anticipating transcatheter aortic valve replacement, coronary artery bypass graft, and other cardiovascular care.Clinics in geriatric medicine,35(4), pp.571- 585. Brieger, D., Chow, C., Gullick, J., Hyun, K., D'Souza, M., Briffa, T. and Concordance Investigators, 2018. Improving patient adherence to secondary prevention medications 6 months after an acute coronary syndrome: observational cohort study.Internal Medicine Journal,48(5), pp.541-549. Caspi-Avissar, N., Grosman-Rimon, L., Gohari, J., Arazi, M., Granot, D., Ghanim, D., Carasso, S., Shalabi, A., Sudarsky, D., Eilat-Adar, S. and Kinany, W., 2021. Clinical, Surgical, and Sociopsychological Factors and Depression After Cardiothoracic Surgery.The Annals of Thoracic Surgery,111(3), pp.1064-1070. Laukkanen, J.A., 2018. Contemporary nationwide cardiology registers: up-to-date registry data are required.European Journal of Preventive Cardiology,25(3), pp.270-272. Pastormerlo, L.E., Aimo, A., Piepoli, M. and Emdin, M., 2018. The bottleneck of cardiac rehabilitation for patients with coronary artery disease: How to overcome.European Journal of Preventive Cardiology,25(12), pp.1239-1241. Samuel,R.,Alfadhel,M.,McAlister,C.,Nestelberger,T.andSaw,J.,2021.Cardiac rehabilitationfollowingcoronaryarterydissection:recommendationsandpatient considerations.Expert review of cardiovascular therapy,19(11), pp.1005-1012. Shah, N.P., AbuHaniyeh, A. and Ahmed, H., 2018. Cardiac rehabilitation: current review of the literature and its role in patients with heart failure.Current Treatment Options in Cardiovascular Medicine,20(2), pp.1-15. Bianchi, M., Bagnasco, A., Bressan, V., Barisone, M., Timmins, F., Rossi, S., Pellegrini, R., Aleo, G. and Sasso, L., 2018. A review of the role of nurse leadership in promoting and sustaining evidence‐based practice.Journal of Nursing Management,26(8), pp.918-932. Melnyk, B.M., Gallagher‐Ford, L., Zellefrow, C., Tucker, S., Thomas, B., Sinnott, L.T. and Tan, A., 2018. The first US study on nurses’ evidence‐based practice competencies indicates major deficits that threaten healthcare quality, safety, and patient outcomes.Worldviews on Evidence‐ Based Nursing,15(1), pp.16-25. Shayan, S.J., Kiwanuka, F. and Nakaye, Z., 2019. Barriers associated with evidence‐based practice among nurses in low‐and middle‐income countries: A systematic review.Worldviews on Evidence‐Based Nursing,16(1), pp.12-20.
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Caliskan, E., De Souza, D.R., Boening, A., Liakopoulos, O.J., Choi, Y.H., Pepper, J., Gibson, C.M., Perrault, L.P., Wolf, R.K., Kim, K.B. and Emmert, M.Y., 2020. Saphenous vein grafts in contemporary coronary artery bypass graft surgery.Nature Reviews Cardiology,17(3), pp.155- 169. Hoyler, M.M., Tam, C.W., Thalappillil, R., Jiang, S., Ma, X., Lui, B. and White, R.S., 2020. The impact of hospital safety‐net burden on mortality and readmission after CABG surgery.Journal of Cardiac Surgery,35(9), pp.2232-2241. Tüfekçi, H., Akansel, N. and Sivrikaya, S.K., 2022. Pain interference with daily living activities and dependency level of patients undergoing CABG surgery.Pain Management Nursing,23(2), pp.180-187. Santoft, F., Axelsson, E., Öst, L.G., Hedman-Lagerlöf, M., Fust, J. and Hedman-Lagerlöf, E., 2019. Cognitive behaviour therapy for depression in primary care: systematic review and meta- analysis.Psychological medicine,49(8), pp.1266-1274. Ugwuanyi, C.S., Gana, C.S., Ugwuanyi, C.C., Ezenwa, D.N., Eya, N.M., Ene, C.U., Nwoye, N.M., Ncheke, D.C., Adene, F.M., Ede, M.O. and Onyishi, C.N., 2020. Efficacy of cognitive behaviour therapy on academic procrastination behaviours among students enrolled in Physics, Chemistry and Mathematics Education (PCME).Journal of Rational-Emotive & Cognitive- Behavior Therapy,38(4), pp.522-539. Online: The effect of cardiac rehabilitation on anxiety and depression in patients undergoing cardiac bypassgraftsurgeryinIran,2012[Online]Availablethrough: <https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/1471-2261-12- 40#Sec13> Evidence Based Practice
Table of Content. INTRODUCTION...........................................................................................................................1 RESEARCH QUESTION................................................................................................................2 RATIONALE FOR RESEARCH QUESTION...............................................................................2 LITERATURE SEARCH................................................................................................................3 Inclusion and Exclusion criteria...................................................................................................3 Search terms using PICO framework..........................................................................................3 DATABASES..................................................................................................................................4 Search strategy Table.......................................................................................................................5 REFERENCES................................................................................................................................6
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INTRODUCTION A CABG is generally a coronary artery bypass graft, surgical process that is used to treat the coronary heart illness. It can generally divert the supply of blood around the clogged or narrowed parts of the major arteries in order to enhance the flow of blood supply as well as the supply of oxygen towards the cardiovascular system. It is a procedure that can help to reduce the developing risk of major complications for the adult age group patients who generally have obstructive coronary artery illness, it is a type of ischaemic cardiovascular illness. The CABG procedure can also be used during an emergency, for example person having major heart attack. The CABG can uses the blood vessels from other parts of the human body as well as can connect them to the blood vessels both above and below the narrowed artery, bypassing the blocked or narrowed coronary arteries. In this, one or may be additional blood vessels can be used, it is depending upon the seriousness as well as the number of blockages. In this, the blood vessels are mainly the arteries from the chest and arm as well or the veins from the legs. The possible risks as well as the complications can occurs along with this operations. In the coronary artery bypass graft operation, it usually lasts about 3 to 6 hours (The effect of cardiac rehabilitation on anxiety and depression in patients undergoing cardiac bypass graft surgery, 2012). But it can take longer time, depending on the number of blood vessels are being attached with cardiovascular system. During procedure, the blood vessels are being taken from the leg of the patient (saphenous vein), inside the chest such as the internal mammary artery, or the arms such as radial artery. While the remaining blood vessels present in the region can compensate for the loss of the blood vessels after the procedure. In this, after coronary artery bypass grafting, the healthcare professionals can recommend the medicines as well as the cardiac healthy lifestyle alterations in order to overcome the symptoms of the patients, can treat the illness as well as help to prevent the complications like blood clots. In this, the advantages of the coronary artery bypass graft procedure with respect to the survival, enhanced the ventricular functioning, independent from the angina and re-stenosis in the coronary artery illness patients are well founded. In addition to this, the long-standing concentration over the psychological factors among CABG patients has indicated a link with the enhanced risk of morbidity among the longer and shorter terms as well. In this research, it will cover the inclusion and exclusion criteria based on the research topic (Latimer, 2020). In addition to this, there is also a discussion about the PICO framework that can 1
illustrate the interventions and other alternative methods used to reduce the impact of depression and anxiety among post CABG patients between age group 40 to 60 years. RESEARCH QUESTION “Does rehabilitation help post CABG patients with anxiety and depression?” RATIONALE FOR RESEARCH QUESTION A coronary artery bypass graft (CABG) is a surgical procedure that are sued to treat coronary heart diseases. This help to enhance the blood flow through the narrowed or clogged part of arteries and help to provide oxygen supply to individual heart. Here, cardiac rehabilitation is effective and allow to get better reduction in depression within individual through surgery withinpatientthroughundergoingcoronaryarterybypassgrafting.Cardiacrehabilitation includes all measures which help people with heart disease which can help in getting satisfy about life to prevent when there is occurrence of cardiac events. This can help patient to avoid through including stages like inpatient, outpatient and ongoing prevention. Here, thorough ongoing prevention help individual in maintaining long term cardiovascular stability along with physical condition (Okati-Aliabad et. al., 2022). Cardiac rehabilitation help individual to help in reduction in depressive symptoms which are associated with excess mortality. Through learning about the educational intervention which allow to reduce depression within patients who underwent CABG. So, it canbe understand that through using the Cardiac rehabilitation for anxiety and depression can help to assist individual to reduce the healthcare costs and help in increasing the patient quality of life. This can help to get help in taking care of the depression and anxiety which get reduce when cardiac rehabilitation is taken by the individual. With the help of cardiologist it can help to get support in treatment of diseases which are related with the cardiovascular system like individual with CABG patient. They are specialist in providing treatment related with health disease which may includes blood vessels and heart (Osailan et. al., 2021). Here, through using the Cardiac rehabilitation can involve cardiologist who can help to support in getting better care and treatment for individual with CABG. This research question perform important role in treatment and care of patient with CABG which can create high impact on particular population with CABG. Although the depression as well as anxiety are significantly the psychological risk factors for the coronary artery illness, the psychological aspects among the patients having heart surgery is generally being less considered. Both the cognitive as well as the psychological deficit has 2
been still concerning in spiteof the notable enhancement of the heart surgery by using the cardiopulmonary bypass perfusion. In this, the main aim of developing the research is to know about the prevalence and trends of the depression and anxiety among the post-coronary artery bypass graft patients as well as to introduce the pharmacological, non-pharmacological as well as other healthy lifestyle interventions. In addition to this, the prevalence of both depression and anxiety of the patients after the procedure has generally been varied from about 10 to 60% and has likely to enhance greater than the normal people. From the research, it is been determined that the patients over the 6 months after their cardiovascular surgery specifically involves the trends such as depression and anxiety among the patients with coronary artery bypass graft without having any extra prevention programs before and after the procedure. In the study, it is identified that the patients with CABG significantly enhanced the scores of depression and anxiety about 3 to 6 months after surgery, the level of anxiety being reduced considerably for about 6 months after the coronary artery bypass graft and then levelled out for some of the time. In addition to this, some of the patients has developed the depression will remain increased about 6 months after the procedure. In this, the longitudinal psychological conditions of the patients with CABG generally have been impacted by not only the invasive coronary artery bypass graft procedure but can also the life events. Furthermore, the non-pharmacological interventions can have enhanced the psychological conditions of the patients. The particular research is effectively required to clarify the very long-term psychological outcomes as well as to improve the effective intervention programs to the patients who have the surgery of coronary artery bypass graft. LITERATURE SEARCH Inclusion and Exclusion criteria. Inclusion criteriaExclusion criteria English language is required. Randomised control trail is taken under the study. The population with the age group of 40 to 60 are selected as inclusion parts within the research process. Pharmacologicalandnon RatherthenEnglishlanguageis excluded from the study. Cohortstudyareconsideredas exclusion part of the study. The children and teenager are excluded within the study. Nonpharmaceuticalintervention 3
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pharmacologicalinterventionis included within the study. especiallyacupunctureandother traditional therapies are excluded from the study. PICO framework: P (Population):The number of adult who are between the age of 40 to 60 faces rehabilitation that can help the post CABGpatients with anxiety and depression. I (Interventions):The interventions used to concentrate on various pharmacological and non- pharmacological interventions, which help to provide the drug therapies, medications and regimens in such a way which is helpful to overcome the complications linked with post CABG patients having anxiety and depression. C (Comparison):Another management is also applicable to overcome the cause and impacts of anxiety and depression within post CABG patients. Furthermore, self-management can involve healthy lifestyle alterations and various other ways that may help adults to minimize the influence. O (Outcome):The pharmacological and non-pharmacological interventions along with self- management can help to decrease the cause of anxiety and depression among post CABG patients between age groups 40 to 60 years. Search terms using PICO framework. Population/ patient group Interventions or issuesComparisonOutcome Impactof depression and anxietyamong postCABG adultpatients age between 40 to 60 years. The impacts of rehabilitation Mechanism actionof Sertraline. Mechanism actionof citalopram. Comparison of bothSertraline and citalopram. The therapeutic impactof medicationsor drugsfor treating depression and anxietyamong postCABG patientsage Enhancedthe conditionof influenceof depression and anxietyamong postCABG patients betweenage group 40 to 60 4
on post CABG adultpatients toreduce influenceof depression and anxiety. Weight control. Management of stress. Adequate amountof physical exercise. Quit smoking. group of 40 to 60 years. Thedrugof choicefor treating anxiety and depression amongpost CABG patients. years. Increased cardiacoutput andhealthy lifestyle. DATABASES There are some of the database which are associated to collect the information through planning search thatare relevant to research question.These database includesPubmed, CINHAL, EMBASE, Cochrane library (Eriksen et. al., 2018). Pubmed provide the free resources that supports search along with retrieval of biomedical alogn with sciences literature that have the aim in improving health. It includes large number of citation and abstracts regarding biomedical literature. It also provide authentic resources about the information which are limited by years and researchers. CINAHAL refers to the cumulated Index to Nursing and Allied Health Literature which allows to search for article form the various nursing journals. It allow to limiting the search as per the assignment criteria (Miura et. al., 2021). EMBASE is a resource of good database which provide the clinical queries about genetics topics. It also includes the systematic review of information which can assist in getting better knowledge about the required information. Cochrane library help to get reflect on the findings through new evidence which can be available due to new studies of result which have the potential to change conclusion of review. It includes the limitation through years and up to date information as per requirement (Frandsen et. al., 2021). Search strategy Table KeywordsorPubMedCINAHAL PlusEMBASETotal 5
REFERENCES Books and Journals: Braunwalder, C., Ehrmann, C., Hodel, J., Müller, R., von Matt, D. and Fekete, C., 2022. Pain trajectoriesduringinitialrehabilitationafterspinalcordinjury:Dopsychosocial resources and mental health predict trajectories?.Archives of Physical Medicine and Rehabilitation. Eriksen, M.B. and Frandsen, T.F., 2018. The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review.Journal of the Medical Library Association: JMLA,106(4), p.420. Frandsen, T.F., Eriksen, M.B., Hammer, D.M.G., Christensen, J.B. and Wallin, J.A., 2021. Using Embase as a supplement to PubMed in Cochrane reviews differed across fields.Journal of Clinical Epidemiology,133, pp.24-31. Galati, A., Piccoli, M., Tourkmani, N., Sgorbini, L., Rossetti, A., Cugusi, L., Bellotto, F., Mercuro, G., Abreu, A. and D’Ascenzi, F., 2018. Cardiac rehabilitation in women: state of the art and strategies to overcome the current barriers.Journal of Cardiovascular Medicine,19(12), pp.689-697. Latimer, K., 2020. The Art of Care: A Report on the 2019 Vizient Connections Education Summit.American Journal of Medical Quality,35(1_suppl), pp.5S-111S. Linden, W., Young, S., Ignaszewski, A. and Campbell, T., 2021. Psychosocial and medical predictors of 14-year mortality and morbidity in male and female coronary artery bypass graft recipients: a prospective observational study.Psychological Medicine, pp.1-12. Marin, T.S., Walsh, S., May, N., Jones, M., Gray, R., Muir-Cochrane, E. and Clark, R.A., 2020. Screening for depression and anxiety among patients with acute coronary syndrome in acute care settings: a scoping review.JBI evidence synthesis,18(9), pp.1932-1969. Miura, Y., Tamai, N., Kitamura, A., Yoshida, M., Takahashi, T., Mugita, Y., Tobita, I., Arita, M., Urai, T., Dai, M. and Noguchi, H., 2021. Diagnostic accuracy of ultrasound examination in detecting aspiration and pharyngeal residue in patients with dysphagia: A systematicreview and meta‐analysis.Japan Journal of Nursing Science,18(2), p.e12396. Okati-Aliabad, H., Ansari-Moghaddam, A., Roohafza, H., Mohammadi, M., Vakili, L., Abbasi, M.H., Heidari, H., Masoudy, G., Yazdekhasti, S. and Sadeghi, M., 2022. The effects of comprehensive home-based cardiac rehabilitation versus usual care in patients with ischemic heart disease in Iran: Study protocol for a multicenter randomized controlled trial.International Journal of Preventive Medicine,13(1), p.4. Osailan, A. and Abdelbasset, W.K., 2020. Exercise-based cardiac rehabilitation for postcoronary artery bypass grafting and its effect on hemodynamic responses and functional capacity evaluatedusingtheIncrementalShuttleWalkingTest:Aretrospectivepilot analysis.Journal of the Saudi Heart Association,32(1), p.25. 7
Pedersen, M., Egerod, I., Overgaard, D., Baastrup, M. and Andersen, I., 2018. Social inequality inphaseIIcardiacrehabilitationattendance:Theimpactofpotential mediators.European Journal of Cardiovascular Nursing,17(4), pp.345-355. Yu, Z., Zhao, Q., Ye, Y., Wang, M., Zhou, Z., Zhang, H., Zhao, Z., Liu, Q., Zhang, Z., Wu, Y. and Xu, H., 2021. Comprehensive Geriatric Assessment and Exercise Capacity in CardiacRehabilitationforPatientsReferredtoTranscatheterAorticValve Implantation.The American Journal of Cardiology,158, pp.98-103. Online: The effect of cardiac rehabilitation on anxiety and depression in patients undergoing cardiac bypassgraftsurgery,2012[Online]Availablethrough: <https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/1471-2261-12-40> 8