This creative project will be a compilation of surgical proceedures performed by the author on patients before a video tape. There was a superimposed narration describing the procedure as it was being performed.Since these tapes were open ended, anytime a patient presented with a problem and a willingness to be taped, a new dimension in resident education is always forthcoming. This project has also forced one author into becoming proficient in the art of surgical techniques and in the art of taping video lectures.Since much of the educational material is in tape of television form now, this will be a readily accepted media in educating future doctors of less frequently mentioned procedures.Three training video tapes, each approximately 10 minutes long were produced dealing with removal of moles from the skin, circumcision, and removal of a toenail.Production was carried out in the surgical suite of the Family Practice Center, Ball Memorial Hospital, Muncie, Indiana during the 1976-77 academic year.

Peripheral arterial disease (PAD) is a common manifestation of stenoses and occlusions of the arteries of the lower extremities. Clinically, PAD is an important effect on functional ability, and quality of life because symptomatic patients are typically able to walk less than one to three blocks before rest is required.The double product break point (DPBP), also defined as the oxygen consumption at which the first portion of nonlinear increase in rate pressure product (systolic blood pressure X heart rate) begins has been identified to determine the anaerobic threshold during exercise test. The purpose of this study was to determine whether the DPBP could be detected in patients with PAD during a symptom-limited GXT on the motor-driven treadmill. Six male subjects (68.2 ± 6.5 yrs) with history of diagnosis of PAD participated in this study. Double product (DP) was assessed every 15 seconds during the test via the Kyokko Bussan CM-4001 automated blood pressure unit. The DPBP and VT were determined visually by three blinded observers. The mean values of Peak V02 and maximal heart rate were 19.4 ± 5.8 (ml/kg/min) and 130 ± 13 (bpm), respectively. In 4 of the six exercise tests in the present study, the DPBP and the VT were determined. The mean V02 at the DPBP and the VT were 15.7 ± 2.6 ml/kg/min and 14.2 ± 0.6 ml/kg/min, corresponding to 73 ± 7.2 and 74.5 ± 5.4 % respectively. In 3 of the six exercise tests both of the DPBP and VT were determined. The Mean V02 at the DPBP and VT were 14.6 ± 1.8 and 14.3 ± 0.7, respectively. The difference of the mean VO2 at the VT and DPBP was -.0.33 ml/kg/min.In conclusion, the results of the present study suggest that the DPBP can be identified and used as a useful marker to determine the functional performance in PAD patients. Walking time or distance measurement depends on the patient's perception of the pain. Thus, this study provides an objective way to appraise the functional performance and therapeutic results obtained from the exercise training in PAD patients, and provides a reference for exercise prescription for this population. / School of Physical Education

Purpose: Cardiac rehabilitation (CR) programs have been shown to promote numerous health benefits among patients with cardiovascular disease (CVD), but little is known about the characteristics of CR programs. Methods: A survey was developed and utilized to collect data on Early Outpatient Cardiac Rehabilitation programs (EOCR) in the USA. An email with a link to the survey was sent by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) to their members. Program directors/administrators were recruited to provide information about their program in operation during 2009 in the United States. The CR survey contained 13 questions, some with multiple answers, regarding the utilization and patient demographics of an Early Outpatient Cardiac Rehabilitation (Phase II) program. Results: Responses were received from 138 programs in 44 states. Of the responses, 19,689 patients completed at least one EOCR exercise session. Of the responses, 68% of patients were men and 32% of patients were women. Patients enrolled in EOCR programs had a primary diagnosis of CABG 4,803 (30%); AVR/MVR 1,401(9%); MI 3,583 (22%); PCI/Stent 4,961 (31%); stable angina 965 (6%); heart/lung transplant 53 (0.33%); other 385 (2%). 8.4% complete 0-6 sessions of EOCR; 12% complete 7-12 sessions; 22% complete 13-18 sessions; and 58% complete 19-36 sessions. 35% of patients enrolled in EOCR programs are discharged early. 84% of programs offer an outpatient maintenance CR program. 96% of EOCR programs offer education classes; 89% offer resistance equipment; 72% are AACVPR certified; 62% also offer pulmonary rehabilitation; 23% utilize outcome measurements; 62% are in rural locations; and the average patient-to-staff ratio is 4.2:1. Conclusions: CR programs are used by a minority of eligible patients. There is marked variation in the structure and content of EOCR programs. Alternative strategies to improve standardization and outcomes should be implemented. / School of Physical Education, Sport, and Exercise Science

Motivation: Ischemic heart disease is the eighth leading cause of death in an African population. Silent ischemia can be defined as an ischemic episode without associated pain. The clinical significance of silent ischemia is growing and can now be considered as a risk factor in the development of coronary disease. Hypertension and associated risk factors, hypercholesterolemia and diabetes are associated with silent ischemia. Other factors such as higher pulse pressure, double product, heart rate and higher carotid intima-media thickness are also associated with silent ischemia. Urbanisation is rising in South-Africa. This new lifestyle is associated with several risk factors including: poor diets, lower physical activity levels, hypertension and increased smoking and alcohol abuse. The prevalence of stroke is high among Africans, which can be due to a higher prevalence of hypertension, diabetes and obesity. Purpose: The purpose of this study was to determine the associations between silent ischemia and cardiovascular function in African men. The focus fell on hypertension and associated risk factors, higher total cholesterol levels, and increased pulse pressure, heart rate and sub-clinical atherosclerosis. vi Methodology: This study constituted a population study in the North-West province carried out on urbanized African male teachers aged between 20-60 years. The SABPA (Sympathetic activity and Ambulatory Blood Pressure in Africans) sub-study consisted of a total of 80 African male volunteers. The Cardiotens apparatus was placed on each participant on the first morning. This apparatus took ambulatory blood pressure measurements as well as Electrocardiogram measurements. Hereafter, participants continued with their normal work day until 1700. After an overnight stay at the Metabolic unit of the North-West University Potchefstroom campus, the apparatus was removed at 0600. During statistical analyses, the African males were divided into groups of participants with silent ischemia (SI) and those without silent ischemia (nSI), as determined by the ambulatory electrocardiogram. Statistical analyses were performed by means of the Statistica version 10 software program. Results: In comparison with the nSI men, the SI showed the following: above normal high sensitivity C-reactive protein and glucose, higher ambulatory blood pressure, heart rate, pulse pressure, resting ST-segment depression and carotid intima-media thickness. Multiple regression analyses indicated that ambulatory silent ischemia is associated with sub-clinical atherosclerosis, possibly increasing their stroke risk. / Thesis (M.Sc. (Physiology))--North-West University, Potchefstroom Campus, 2012.

Motivation: Ischemic heart disease is the eighth leading cause of death in an African population. Silent ischemia can be defined as an ischemic episode without associated pain. The clinical significance of silent ischemia is growing and can now be considered as a risk factor in the development of coronary disease. Hypertension and associated risk factors, hypercholesterolemia and diabetes are associated with silent ischemia. Other factors such as higher pulse pressure, double product, heart rate and higher carotid intima-media thickness are also associated with silent ischemia. Urbanisation is rising in South-Africa. This new lifestyle is associated with several risk factors including: poor diets, lower physical activity levels, hypertension and increased smoking and alcohol abuse. The prevalence of stroke is high among Africans, which can be due to a higher prevalence of hypertension, diabetes and obesity. Purpose: The purpose of this study was to determine the associations between silent ischemia and cardiovascular function in African men. The focus fell on hypertension and associated risk factors, higher total cholesterol levels, and increased pulse pressure, heart rate and sub-clinical atherosclerosis. vi Methodology: This study constituted a population study in the North-West province carried out on urbanized African male teachers aged between 20-60 years. The SABPA (Sympathetic activity and Ambulatory Blood Pressure in Africans) sub-study consisted of a total of 80 African male volunteers. The Cardiotens apparatus was placed on each participant on the first morning. This apparatus took ambulatory blood pressure measurements as well as Electrocardiogram measurements. Hereafter, participants continued with their normal work day until 1700. After an overnight stay at the Metabolic unit of the North-West University Potchefstroom campus, the apparatus was removed at 0600. During statistical analyses, the African males were divided into groups of participants with silent ischemia (SI) and those without silent ischemia (nSI), as determined by the ambulatory electrocardiogram. Statistical analyses were performed by means of the Statistica version 10 software program. Results: In comparison with the nSI men, the SI showed the following: above normal high sensitivity C-reactive protein and glucose, higher ambulatory blood pressure, heart rate, pulse pressure, resting ST-segment depression and carotid intima-media thickness. Multiple regression analyses indicated that ambulatory silent ischemia is associated with sub-clinical atherosclerosis, possibly increasing their stroke risk. / Thesis (M.Sc. (Physiology))--North-West University, Potchefstroom Campus, 2012.

Introduction: Induced abortion is a common medical intervention. Whether psychological sequelae might follow induced abortion has long been a subject of concern among researchers, and there is lack of knowledge about the relationship between posttraumatic disorder (PTSD) and induced abortion. Aims: To study and compare PTSD, posttraumatic stress symptoms (PTSS) and anxiety- and depressive symptoms among women seeking abortion, allowing for demographic variables. Further aims were to assess risk factors and to assess PTSD and PTSS following induced abortion in relation to experienced care at the clinic. Methods: This was a multi-centre cohort study targeting women who requested an induced abortion at the outpatient clinics of the gynaecology and obstetrics departments of six public hospitals in Sweden. All women who requested an induced abortion before the end of gestational week 12 were approached for participation. PTSD, PTSS, anxiety- and depressive symptoms, personality traits and women’s perceptions of abortion care were measured by means of questionnaires. Measurements were made at the first visit before the abortion as well as three- and six-months thereafter. Data collection was performed from September 2009 to January 2011. Results: 1,514 women filled out the questionnaire before the abortion. Abortion-seeking women did not suffer from PTSD to a greater extent than the general Swedish female population. Few women (51/720) developed PTSD or PTSS after the abortion, 11 did so due to trauma experience related to the abortion. Women at risk of posttraumatic stress were more likely to be young, having anxiety- or depressive symptoms and personality traits related to neuroticism. Furthermore, women with PTSD or PTSS were more likely to perceive certain aspects of the abortion care as deficient. Conclusions: The vast majority of women coped well with the induced abortion. Few developed posttraumatic stress post abortion. The majority did so because of trauma experiences unrelated to the induced abortion. Young women and women with mental distress are vulnerable groups that need to be paid attention to in abortion care. These women are at risk for negative experiences of the abortion care, and may be at risk of PTSD or PTSS post abortion / <p>Contact: Sophiahemmet University, Box 5605, SE-114 86 Stockholm, Sweden</p>

Health system restructuring combined with the preferences of palliative care recipients to be cared for at home has lead to a shift in the delivery of care from the hospital to the home setting. An analysis was conducted on five main home-based palliative care health service components: home-based nurse visits, home personal support worker visits, home-based physician visits, ambulatory physician visits, and other ambulatory and home-based visits. First, we assessed the proportion of total cost associated with the main services at different time points over the palliative care trajectory. Second we examined the socio-demographic and clinical factors that predict the propensity and intensity of service use, using a two-part model. The results suggest that the greatest contributor to the total cost of home-based palliative care was personal support worker visits, followed by nurse visits. The regression analysis revealed that patient age as well as functional status most often predicted health service use.

Previous research has reported positive associations between anger, perceived stress and blood pressure. These associations have largely been based on cross-sectional data and a small number of longitudinal works. Using a prospective longitudinal cohort design, this study more directly tested the relationships between anger, perceived stress and blood pressure by using a psychological therapeutic intervention (mindfulness-based stress reduction) to manipulate anger and perceived stress. Anger and perceived stress were in turn evaluated for association with blood pressure. Despite improvements in psychosocial functioning and reductions in blood pressure, findings from this study failed to demonstrate an association between change in anger or perceived stress with change in daytime or 24-hour ambulatory blood pressure. A model where these variables interact indirectly via stress coping mechanisms or health behaviours may be the linking mechanism in this study. Results from this thesis have contributed evidence to a divided field dominated by cross-sectional research.

Health system restructuring combined with the preferences of palliative care recipients to be cared for at home has lead to a shift in the delivery of care from the hospital to the home setting. An analysis was conducted on five main home-based palliative care health service components: home-based nurse visits, home personal support worker visits, home-based physician visits, ambulatory physician visits, and other ambulatory and home-based visits. First, we assessed the proportion of total cost associated with the main services at different time points over the palliative care trajectory. Second we examined the socio-demographic and clinical factors that predict the propensity and intensity of service use, using a two-part model. The results suggest that the greatest contributor to the total cost of home-based palliative care was personal support worker visits, followed by nurse visits. The regression analysis revealed that patient age as well as functional status most often predicted health service use.

Previous research has reported positive associations between anger, perceived stress and blood pressure. These associations have largely been based on cross-sectional data and a small number of longitudinal works. Using a prospective longitudinal cohort design, this study more directly tested the relationships between anger, perceived stress and blood pressure by using a psychological therapeutic intervention (mindfulness-based stress reduction) to manipulate anger and perceived stress. Anger and perceived stress were in turn evaluated for association with blood pressure. Despite improvements in psychosocial functioning and reductions in blood pressure, findings from this study failed to demonstrate an association between change in anger or perceived stress with change in daytime or 24-hour ambulatory blood pressure. A model where these variables interact indirectly via stress coping mechanisms or health behaviours may be the linking mechanism in this study. Results from this thesis have contributed evidence to a divided field dominated by cross-sectional research.