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Objective To determine factors that contribute to living well with aphasia in the first 12 months poststroke. Design Prospective longitudinal cohort study. Setting Hospitalized care, ambulatory care, and general community. Participants A referred sample of people (N=58) with a first incidence of aphasia after stroke was assessed at 3, 6, 9, and 12 months postonset. Participants were recruited through speech-language pathologists in 2 capital cities in Australia. Presence of aphasia was determined through the Western Aphasia Battery-Revised by an experienced speech-language pathologist. Interventions Not applicable. Main Outcome Measures The main outcomes were the 5 domains of the Assessment for Living with Aphasia at 3, 6, 9, and 12 months poststroke. The independent variables included demographics, physical functioning, social network, mood, aphasia severity, and a self-rating of successfully living with aphasia at the same time points. Mixed effects modeling was used to determine which factors contributed to the trajectory of each of the 5 domains of participation, impairment, environment, personal factors, and life with aphasia. Results Higher household income, larger social network size, being a woman, and having milder aphasia were positively associated with the participation domain. Graduate or postgraduate educational levels, low mood, and poor physical functioning were negatively associated with the participation domain. Factors positively associated with other domains included higher income, self-ratings of successfully living with aphasia, and aphasia severity. Low mood was consistently negatively associated with all of the domains. Conclusions Psychosocial determinants were the most significant predictors of living well with aphasia in the first 12 months postonset. Aphasia rehabilitation needs to attend more to these factors to optimize outcomes.

Objective: To document incidence of depression, anxiety, and stress in women more than 6 months following an acute coronary syndrome. Design: Participants were identified from a coronary care unit database. The Depression Anxiety Stress Scales 21 (DASS 21) was sent to potential participants via postal survey. Setting: A metropolitan teaching hospital in Melbourne, Australia. Participants: The cohort of women was aged between 55 and 70 years. They had been admitted to hospital with a diagnosis of acute coronary syndrome (ACS) between 6 and 14 months prior to participating in this study. Main outcome measures: Scores on Depression, Anxiety, and Stress Scale (DASS 21). Results: Of the 117 posted questionnaires, 39 women with a mean age of 63 (S.D. 4.97) responded to the survey, representing a response rate of 33.3%. Most participants scored within normal levels of depression (66.7%), anxiety (60.5%), and stress (70.3%), however, mild to extremely severe levels of each construct (33.4%, 39.6%, and 29.7%, respectively) were found. Conclusions: The reporting of elevated levels of depression, anxiety and stress in a subset of women more than 6 months following an ACS event underscores the importance of ongoing screening for risk factors impacting on psychological well-being and the inclusion of this information in education and counseling strategies in both the inpatient and outpatient settings. Based on these pilot data, consideration of a screening system in the immediate post discharge period for women at risk and an education or support service are recommended. © 2007 Australian College of Critical Care Nurses Ltd.

Heart Failure Management Programs (HFMPs) have proven to be cost-effective in minimising recurrent hospitalisations, morbidity and mortality. However, variability between the programs exists which could translate into variable health outcomes.To survey the characteristics of HFMPs throughout Australia and to identify potential heterogeneity in their organisation and structure.Thirty-nine post-discharge HFMPs were identified from a systematic search of the Australian health-care system in 2002. A comprehensive 19-item questionnaire specifically examining characteristics of HFMPs was sent to co-ordinators of identified programs in early 2003.All participants responded with six institutions (15%) indicating that their HFMP had ceased operations due to a lack of funding. The survey revealed an uneven distribution of the 33 active HFMPs operating throughout Australia. Overall, 4450 post-discharge HF patients (median: 74; IQR: 24-147) were managed via these programs, representing only 11% of the potential caseload for an Australia-wide network of HFMPs. Heterogeneity of these programs existed in respect to the model of care applied within the program (70% applied a home-based program and 18% a specialist HF clinic) and applied interventions (30% of programs had no discharge criteria and 45% of programs prevented nurses administering/titrating medications). Sustained funding was available to only 52% of the active HFMPs.Inequity of access to HFMPs in Australia is evident in relation to locality and high service demand, further complicated by inadequate funding. Heterogeneity between these programs is substantial. The development of national benchmarks for evidence-based HFMPs is required to address program variability and funding issues to realise their potential to improve health outcomes.

Background Despite the importance of the sodium-restricted diet (SRD) to heart failure (HF) management, patient adherence is poor. Little is known about gender differences in adherence or factors that affect patients' ability to follow SRD recommendations. The purposes of this study were to determine whether there were gender differences in (1) adherence to the SRD; (2) knowledge about SRD and HF self-care; and (3) perceived barriers to following the SRD. Methods and Results Forty-one men and 27 women completed the Heart Failure Attitudes and Barriers questionnaire that measured HF self-care, knowledge, and perceived barriers to follow an SRD. Diet adherence was measured by 24-hour urinary sodium excretion (UNa). Women were more adherent to the SRD than men as reflected by 24-hour urine excretion (2713 versus 3859 mg UNa, P = .01). Women recognized signs of excess sodium intake such as fluid buildup ( P = .001) and edema ( P = .01) more often than men and had better understanding of appropriate actions to take related to following an SRD. There were no gender differences in perceived barriers to follow an SRD. Conclusions Although men and women perceived similar barriers, women were more adherent to the SRD and had greater knowledge about following an SRD. Further investigation of this phenomenon is warranted to determine if better adherence contributes to improved outcomes in women.

Background The acute illness phase following coronary artery bypass graft (CABG) surgery is a difficult time for patients as they try to adjust to the physical and emotional changes brought about by surgery. Aims To conduct an indepth examination of psychosocial issues experienced by patients post-CABG surgery and how patients manage these psychosocial issues during their recovery. Methods A qualitative research approach, naturalistic inquiry, guided the study. Thirty patients were interviewed 4–5 weeks following discharge from hospital after CABG surgery and at 12 months after the initial interview. Results esults found that adjusting to life after surgery was difficult, and patients experienced some form of physical pain or change. An unexpected finding was the extent to which many of the patients were attuned to their post-operative physical adjustments. Patients spoke of mental and emotional changes, and coming to terms with lifestyle adjustments. Conclusion Study findings suggest the need for a re-examination of hospital discharge preparation and further provision and monitoring of home support services.