- Email: [email protected]
Running with a VAD
S222
The Journal of Heart and Lung Transplantation, Vol 32, No 4S, April 2014
(n= 9); retired 25% (n= 35); long term sick leave 14% (n= 20); unemployed 20% (n= 28). Restricting factors for work: See diagram. ‘Other’ factors limiting ability to work include health and functional issues, variability of health, and impact of transplant (appointments, medical regime, dialysis). Support requirements: Patients indicated that they required support in the first year post transplant, that individualised specialist advice was required and that liaison with their employer to educate about the impact of transplantation was essential. Conclusion: Occupational status is an important indicator of how well the transplant patient is. Only a small proportion are employed post transplant (34%). The vocational needs of LTR patients are not being fully met. This area needs further research and there is potential for specialist services to meet the needs of this patient group.
5( 98) The New Normal: A Bourdieusian Examination of Living Into Young Adulthood Being a Paediatric Heart Transplant Recipient O. Mauthner ,1 J. Angus,2 D. Gastaldo,2 H. Ross.3 1University of Toronto, Toronto, ON, Canada; 2Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada; 3Heart Failure and Transplantation, University Health Network, Toronto, ON, Canada. Purpose: Improved success of paediatric cardiac transplantation has resulted in increased survival of recipients into young adulthood (19 to 29 years of age). As survival and longevity increase, it is clear that transplant recipients experience negative physiological, psychological and social sequelae. With heart transplant offering individuals a chance to extend life into young adulthood, recipients need lifelong care and at age 18 they transition from paediatric to adult healthcare facilities. This research project applied Pierre Bourdieu’s theoretical concepts of habitus, field and capital to conceptualize and engage with empirical knowledge production about young adults who received a heart transplant during childhood. Methods: Using visual methodology, focused open-ended interviews were conducted with 12 young adults who had a heart transplant during childhood. This study involved an iterative process to investigate transplant recipients’ identities and social re-positioning in relation to dominant discourses of organ transplant and shifting relationships with health services providers. Results: Findings highlight that young adults struggled to reconcile the competing values of their social fields and the healthcare field. Recipients adopt practices of accommodation and “normalization”, which lead to exclusion from various fields of social engagement. Their effort to be “normal” led to conflict about identity, practical routines and status of young adult transplant recipients. This lead to an image where they put up a strong front and eventually cried alone. A particular contribution was to advance thinking about the multi-faceted social positionings occupied by young recipients and their struggle with competing demands. Conclusion: Changes in healthcare practices, attuned to person implications can begin to address young recipients’ contradictory social positions. Also, by establishing much needed peer interaction through young adult transplant clinics, recipients would be given an opportunity to have a dialogue about social survival. Such an approach can potentially lead to improvement in ongoing care for young adults and eventually increase their adherence to medical recommendations. At the same time, it will allow nurses to better prepare and counsel young individuals who are preparing for a heart transplant.
5( 99) Running with a VAD L.M. Fuller ,1 J.M. Van Weel,2 R. Stornebrink,3 A.T. Burge,1 K. Hayes,1 A. Fuller,4 P. Bergin.3 1Physiotherapy, The Alfred Hospital, Melbourne, Australia; 2Physiotherapy, Monash University, Melbourne, Australia; 3Heart Transplant Services, The Alfred Hospital, Melbourne, Australia; 4Infectious Diseases, The Alfred Hospital, Melbourne, Australia. Purpose: Ventricular assist devices (VAD) are commonly used as a bridge to cardiac transplantation (OHTX). Insertion of a VAD improves both quality of life and functional exercise capacity. No studies have investigated supervised progressive running training for VAD patients awaiting OHTX.This study investigated changes in 6 minute walk distance (6MWD) for VAD patients who had running training as a component of an exercise rehabilitation program from device insertion to post transplantation rehabilitation. Methods: After VAD insertion, patients attended an exercise training program consisting of cardiovascular training on bike ergometer and treadmill and upper limb (UL), lower limb(LL) strength training, thrice weekly. Once 5.8 km per hour treadmill walking speed was achieved, incremental running training commenced. 6mwd data was collected monthly. Incidence of drive line infections was recorded. Post OHTX, the rehabilitation program was a supervised, outpatient, 3 month thrice weekly program of the same format as pre transplant. Results: 31 VAD patients underwent OHTX, 87% male, mean age of 46 years with 47% having pre Tx diagnosis of dilated cardiomyopathy. 16 VAD patients achieved running. Post OHTX, patients attended 28 (mean SD 8) exercise sessions. Hospital LOS post Tx was not different between runners (mean 21(SD13) days and non-runners (27 (23)days p= 0.58). Runners (mean 424 (SD100) m) compared to non-runners (324 ( 79) m) had greater 6mwd on entry to post OHTX exercise program (p= 0.004). Runners compared to non-runners also had a significantly greater response in 6MWD following completion of post Tx exercise program (mean 646(SD 83)m vs 554(71)m p= 0.003). No significant association between running and driveline infection (p= 0.6). No adverse events occurred. Conclusion: Running training with a VAD is safe and feasible, not associated with any increase in driveline infections and may improve functional exercise capacity more than non-runners after OHTX. 6( 00) Getting Ready and Then Keeping Quiet? Exploring Grief With Pre and Post-Transplant Patients J.M. Poole ,1 J. Ward,2 E. De Luca,3 M. Shildrick,4 S. Abbey,5 O. Mauthner,6 M. Gewarges,7 H.J. Ross.8 1School of Social Work, Ryerson University, Toronto, ON, Canada; 2School of Social Work, Laurier University, Waterloo, ON, Canada; 3Department of Cardiology and Transplantation, University Health Network, Toronto, ON, Canada; 4The Department of Thematic Studies - Gender Studies, Linköping University, Linköping, Sweden; 5Department of Psychiatry,, University Health Network, University of Toronto, Toronto, ON, Canada; 6Department of Cardiology and Transplantation, University Health Network, Toronto, ON, Canada; 7Faculty of Medicine, University of Toronto, Toronto, ON, Canada; 8Department of Cardiology and Transplantation, University Health Network, University of Toronto, Toronto, ON, Canada. Purpose: Grief, bereavement and loss are not well explored in the clinical heart transplant literature, and yet they may be common experiences for patients waiting for and living with new organs. Previously, we explored heart transplant recipients’ experiences with transplantation and found distress in 88%. We then explored life for patients listed for transplant and found profound feelings of loss in 100% of patients. The purpose of this secondary qualitative analysis was to further explore grief, bereavement and loss in both groups. Methods: Focused open-ended interviews were conducted in a non-clinical setting with 23 patients listed for transplant [52% male, mean age 51.5± 9 years; mean 7.4± 7.3 months on list] and 27 medically stable heart transplant recipients [70% male, mean age 53 yrs± 13.77; range 18-72; mean time since transplant 4.06 yrs± 2.42]. Interviews were audio/video-taped and were transcribed verbatim. NVivo8 qualitative software was used to code text and body language, volume and tone in keeping with our published qualitative visual methodology. Data from 15 participants in each cohort who had spoken of loss were then selected for more in depth audiovisual analysis.
The Journal of Heart and Lung Transplantation, Vol 32, No 4S, April 2014
(n= 9); retired 25% (n= 35); long term sick leave 14% (n= 20); unemployed 20% (n= 28). Restricting factors for work: See diagram. ‘Other’ factors limiting ability to work include health and functional issues, variability of health, and impact of transplant (appointments, medical regime, dialysis). Support requirements: Patients indicated that they required support in the first year post transplant, that individualised specialist advice was required and that liaison with their employer to educate about the impact of transplantation was essential. Conclusion: Occupational status is an important indicator of how well the transplant patient is. Only a small proportion are employed post transplant (34%). The vocational needs of LTR patients are not being fully met. This area needs further research and there is potential for specialist services to meet the needs of this patient group.
5( 98) The New Normal: A Bourdieusian Examination of Living Into Young Adulthood Being a Paediatric Heart Transplant Recipient O. Mauthner ,1 J. Angus,2 D. Gastaldo,2 H. Ross.3 1University of Toronto, Toronto, ON, Canada; 2Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada; 3Heart Failure and Transplantation, University Health Network, Toronto, ON, Canada. Purpose: Improved success of paediatric cardiac transplantation has resulted in increased survival of recipients into young adulthood (19 to 29 years of age). As survival and longevity increase, it is clear that transplant recipients experience negative physiological, psychological and social sequelae. With heart transplant offering individuals a chance to extend life into young adulthood, recipients need lifelong care and at age 18 they transition from paediatric to adult healthcare facilities. This research project applied Pierre Bourdieu’s theoretical concepts of habitus, field and capital to conceptualize and engage with empirical knowledge production about young adults who received a heart transplant during childhood. Methods: Using visual methodology, focused open-ended interviews were conducted with 12 young adults who had a heart transplant during childhood. This study involved an iterative process to investigate transplant recipients’ identities and social re-positioning in relation to dominant discourses of organ transplant and shifting relationships with health services providers. Results: Findings highlight that young adults struggled to reconcile the competing values of their social fields and the healthcare field. Recipients adopt practices of accommodation and “normalization”, which lead to exclusion from various fields of social engagement. Their effort to be “normal” led to conflict about identity, practical routines and status of young adult transplant recipients. This lead to an image where they put up a strong front and eventually cried alone. A particular contribution was to advance thinking about the multi-faceted social positionings occupied by young recipients and their struggle with competing demands. Conclusion: Changes in healthcare practices, attuned to person implications can begin to address young recipients’ contradictory social positions. Also, by establishing much needed peer interaction through young adult transplant clinics, recipients would be given an opportunity to have a dialogue about social survival. Such an approach can potentially lead to improvement in ongoing care for young adults and eventually increase their adherence to medical recommendations. At the same time, it will allow nurses to better prepare and counsel young individuals who are preparing for a heart transplant.
5( 99) Running with a VAD L.M. Fuller ,1 J.M. Van Weel,2 R. Stornebrink,3 A.T. Burge,1 K. Hayes,1 A. Fuller,4 P. Bergin.3 1Physiotherapy, The Alfred Hospital, Melbourne, Australia; 2Physiotherapy, Monash University, Melbourne, Australia; 3Heart Transplant Services, The Alfred Hospital, Melbourne, Australia; 4Infectious Diseases, The Alfred Hospital, Melbourne, Australia. Purpose: Ventricular assist devices (VAD) are commonly used as a bridge to cardiac transplantation (OHTX). Insertion of a VAD improves both quality of life and functional exercise capacity. No studies have investigated supervised progressive running training for VAD patients awaiting OHTX.This study investigated changes in 6 minute walk distance (6MWD) for VAD patients who had running training as a component of an exercise rehabilitation program from device insertion to post transplantation rehabilitation. Methods: After VAD insertion, patients attended an exercise training program consisting of cardiovascular training on bike ergometer and treadmill and upper limb (UL), lower limb(LL) strength training, thrice weekly. Once 5.8 km per hour treadmill walking speed was achieved, incremental running training commenced. 6mwd data was collected monthly. Incidence of drive line infections was recorded. Post OHTX, the rehabilitation program was a supervised, outpatient, 3 month thrice weekly program of the same format as pre transplant. Results: 31 VAD patients underwent OHTX, 87% male, mean age of 46 years with 47% having pre Tx diagnosis of dilated cardiomyopathy. 16 VAD patients achieved running. Post OHTX, patients attended 28 (mean SD 8) exercise sessions. Hospital LOS post Tx was not different between runners (mean 21(SD13) days and non-runners (27 (23)days p= 0.58). Runners (mean 424 (SD100) m) compared to non-runners (324 ( 79) m) had greater 6mwd on entry to post OHTX exercise program (p= 0.004). Runners compared to non-runners also had a significantly greater response in 6MWD following completion of post Tx exercise program (mean 646(SD 83)m vs 554(71)m p= 0.003). No significant association between running and driveline infection (p= 0.6). No adverse events occurred. Conclusion: Running training with a VAD is safe and feasible, not associated with any increase in driveline infections and may improve functional exercise capacity more than non-runners after OHTX. 6( 00) Getting Ready and Then Keeping Quiet? Exploring Grief With Pre and Post-Transplant Patients J.M. Poole ,1 J. Ward,2 E. De Luca,3 M. Shildrick,4 S. Abbey,5 O. Mauthner,6 M. Gewarges,7 H.J. Ross.8 1School of Social Work, Ryerson University, Toronto, ON, Canada; 2School of Social Work, Laurier University, Waterloo, ON, Canada; 3Department of Cardiology and Transplantation, University Health Network, Toronto, ON, Canada; 4The Department of Thematic Studies - Gender Studies, Linköping University, Linköping, Sweden; 5Department of Psychiatry,, University Health Network, University of Toronto, Toronto, ON, Canada; 6Department of Cardiology and Transplantation, University Health Network, Toronto, ON, Canada; 7Faculty of Medicine, University of Toronto, Toronto, ON, Canada; 8Department of Cardiology and Transplantation, University Health Network, University of Toronto, Toronto, ON, Canada. Purpose: Grief, bereavement and loss are not well explored in the clinical heart transplant literature, and yet they may be common experiences for patients waiting for and living with new organs. Previously, we explored heart transplant recipients’ experiences with transplantation and found distress in 88%. We then explored life for patients listed for transplant and found profound feelings of loss in 100% of patients. The purpose of this secondary qualitative analysis was to further explore grief, bereavement and loss in both groups. Methods: Focused open-ended interviews were conducted in a non-clinical setting with 23 patients listed for transplant [52% male, mean age 51.5± 9 years; mean 7.4± 7.3 months on list] and 27 medically stable heart transplant recipients [70% male, mean age 53 yrs± 13.77; range 18-72; mean time since transplant 4.06 yrs± 2.42]. Interviews were audio/video-taped and were transcribed verbatim. NVivo8 qualitative software was used to code text and body language, volume and tone in keeping with our published qualitative visual methodology. Data from 15 participants in each cohort who had spoken of loss were then selected for more in depth audiovisual analysis.