Coronary artery disease (CAD) is known as the second killer in Hong Kong. The Hong Kong Hospital Authority reported nearly 7000 patients suffered from acute myocardial infarction (AMI) in year 2010 to 2011. Percutaneous transluminal coronary angioplasty (PTCA) is a minimal access surgical treatment for coronary artery disease but studies have shown that patients experienced different levels of anxiety before and during PTCA which led negative impact to the patients. Music can be regarded as a safe, cost-effective therapy to reduce one’s anxiety level. It can be carried out by nurses without any specific technique. However, there was no systemic review for using music therapy to patients undergoing PTCA. Therefore, this dissertation aims to evaluate the best available evidence on using music therapy for patients undergoing PTCA. Four electronic databases, Medline, CINAHL, Embase & PsycINFO, were searched for studies to investigate the efficacy of music therapy in patients undergoing PTCA. There were seven studies were eligible with data extracted and quality assessment performed by the critical appraisal skill programme (CASP) checklist. Four studies were graded as high quality, which consistently demonstrated a statistically significant more reduction in the anxiety level of patients who received music therapy either before and/or during PTCA than those who had no music therapy. Consequently, an evidence-based guideline of using music therapy for patients undergoing PTCA was developed according to the guideline development process of SIGN (2010). The use of music therapy is transferable and feasibly in the local setting with little manpower concern. The total cost estimated for running the innovation for a year was HKD 83,775 which was considered as cost-effective to reduce patients’ anxiety level and avoid associated adverse events. A 14-months programme including communication with the stakeholders, pilot testing, staff training and clinical application of the proposed music therapy was designed. Qualitative and quantitative data on patient, healthcare provider and system outcomes would be accounted throughout the programme. The effectiveness of the guideline would be determined by the reduction of patient’s anxiety level by using the Chinese version of State-Trait Anxiety Inventory (STAI) (Shek, 1993). Moreover, healthcare provider outcome would be evaluated by questionnaire and the expenditure of the proposed music therapy would be monitored closely. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Die vorliegende Arbeit beschäftigt sich mit der altersabhängigen Inzidenz und den Risikofaktoren für das Auftreten von lokalen Gefäßkomplikationen nach Herzkathetern über den femoralen Zugang. Diese sind die häufigsten Komplikationen nach Herzkatheteruntersuchungen überhaupt. Besonders berücksichtigt wurden multimorbide und sehr alte Patienten. Durch den demographischen Wandel und eine stetig wachsende Zahl an durchgeführten Herzkatheterprozeduren wird das Aufkommen solcher Patienten in der Zukunft weiter ansteigen. Der Zugang über die Leistengefäße stellt vielerorts noch immer den meistgenutzten dar. Frühere Studien konnten bereits diverse Risikofaktoren für das Auftreten von lokalen Gefäßkomplikationen nach Herzkathetern ermitteln, unter anderem hohes Alter und typische Alterskrankheiten. In den untersuchten teils sehr kleinen Kohorten wurden oft außerordentlich hohe Komplikationsraten ermittelt. Um zu verhindern, dass alten Patienten aus Sorge um mögliche Komplikationen potentiell lebensrettende invasive Maßnahmen vorenthalten werden, ist eine stetige Risikoevaluation notwendig. In dieser Studie wurden 42.628 Prozeduren bei Patienten, die am Herzzentrum Leipzig zwischen 2005 und 2009 einen diagnostischen Herzkatheter oder eine perkutane Koronarintervention (PCI) erhielten, ausgewertet. Ziel der Arbeit war es, die altersabhängigen Komplikationsraten sowie Prädiktoren für das Auftreten von Komplikationen zu ermitteln. Dazu wurden für drei Altersgruppen (Patienten unter 65, zwischen 65 und 79 sowie über 80 Jahre) jeweils prozedurale und klinische Parameter analysiert. Es wurde ein moderater Anstieg der Komplikationsraten festgestellt. Dies zeigt, dass Herzkatheter über einen Leistenzugang bis ins hohe Alter ein sicheres Verfahren sind. Die ermittelten Prädiktoren können einer klinischen Risikostratifizierung dienen.

Thesis (Ph. D.)--University of Missouri--Columbia, 1998. / Typescript. Vita. Includes bibliographical references (leaves: 104-107). Also available on the Internet.

Thesis (M.S.)--University of Michigan, 1979.

Issued also as thesis, Oslo.

Issued also as thesis, Oslo.

Thesis (M.S.)--University of Michigan, 1979.

<p>Patients undergoing cardiac catheterization are potentially at risk of radiation-induced health effects from the interventional fluoroscopic X-ray imaging used throughout the clinical procedure. The amount of radiation exposure is highly dependent on the complexity of the procedure and the level of optimization in imaging parameters applied by the clinician. For cardiac catheterization, patient radiation dosimetry, for key organs as well as whole-body effective, is challenging due to the lack of fixed imaging protocols, unlike other common X-ray based imaging modalities. </p><p>Pediatric patients are at a greater risk compared to adults due to their greater cellular radio-sensitivities as well as longer remaining life-expectancy following the radiation exposure. In terms of radiation dosimetry, they are often more challenging due to greater variation in body size, which often triggers a wider range of imaging parameters in modern imaging systems with automatic dose rate modulation. </p><p>The overall objective of this dissertation was to develop a comprehensive method of radiation dose estimation for pediatric patients undergoing cardiac catheterization. In this dissertation, the research is divided into two main parts: the Physics Component and the Clinical Component. A proof-of-principle study focused on two patient age groups (Newborn and Five-year-old), one popular biplane imaging system, and the clinical practice of two pediatric cardiologists at one large academic medical center. </p><p>The Physics Component includes experiments relevant to the physical measurement of patient organ dose using high-sensitivity MOSFET dosimeters placed in anthropomorphic pediatric phantoms. </p><p>First, the three-dimensional angular dependence of MOSFET detectors in scatter medium under fluoroscopic irradiation was characterized. A custom-made spherical scatter phantom was used to measure response variations in three-dimensional angular orientations. The results were to be used as angular dependence correction factors for the MOSFET organ dose measurements in the following studies. Minor angular dependence (< ±20% at all angles tested, < ±10% at clinically relevant angles in cardiac catheterization) was observed.</p><p>Second, the cardiac dose for common fluoroscopic imaging techniques for pediatric patients in the two age groups was measured. Imaging technique settings with variations of individual key imaging parameters were tested to observe the quantitative effect of imaging optimization or lack thereof. Along with each measurement, the two standard system output indices, the Air Kerma (AK) and Dose-Area Product (DAP), were also recorded and compared to the measured cardiac and skin doses – the lack of correlation between the indices and the organ doses shed light to the substantial limitation of the indices in representing patient radiation dose, at least within the scope of this dissertation.</p><p>Third, the effective dose (ED) for Posterior-Anterior and Lateral fluoroscopic imaging techniques for pediatric patients in the two age groups was determined. In addition, the dosimetric effect of removing the anti-scatter grid was studied, for which a factor-of-two ED rate reduction was observed for the imaging techniques. </p><p>The Clinical Component involved analytical research to develop a validated retrospective cardiac dose reconstruction formulation and to propose the new Optimization Index which evaluates the level of optimization of the clinician’s imaging usage during a procedure; and small sample group of actual procedures were used to demonstrate applicability of these formulations.</p><p>In its entirety, the research represents a first-of-its-kind comprehensive approach in radiation dosimetry for pediatric cardiac catheterization; and separately, it is also modular enough that each individual section can serve as study templates for small-scale dosimetric studies of similar purposes. The data collected and algorithmic formulations developed can be of use in areas of personalized patient dosimetry, clinician training, image quality studies and radiation-associated health effect research.</p> / Dissertation

Submitted by IGOR RIBEIRO DE CASTRO BIENERT (bienert@terra.com.br) on 2016-01-29T14:19:19Z No. of bitstreams: 2 Tese Igor R C Bienert versao final para arquivamento.pdf: 2600270 bytes, checksum: 99be667aca0d1c9255e8b1f9002d9a85 (MD5) Bienert_et_al BMJ Innovations.pdf: 1803372 bytes, checksum: 31c4180b21a1482a1a0afcc7856c9b78 (MD5) / Rejected by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br), reason: Solicitamos que realize uma nova submissão seguindo as orientações abaixo: Foram submetidos 2 arquivos PDF’s, apenas 1 arquivo deve ser submetido (o que contém a Tese ou Dissertação) Corrija estas informações e realize uma nova submissão contendo o arquivo correto. Agradecemos a compreensão. on 2016-02-02T12:39:46Z (GMT) / Submitted by IGOR RIBEIRO DE CASTRO BIENERT (bienert@terra.com.br) on 2016-02-19T20:50:56Z No. of bitstreams: 2 Tese Igor R C Bienert versao final para arquivamento.pdf: 2600270 bytes, checksum: 99be667aca0d1c9255e8b1f9002d9a85 (MD5) Bienert_et_al BMJ Innovations.pdf: 1803372 bytes, checksum: 31c4180b21a1482a1a0afcc7856c9b78 (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-02-23T13:21:58Z (GMT) No. of bitstreams: 1 bienert_irc_dr_bot.pdf: 2600270 bytes, checksum: 99be667aca0d1c9255e8b1f9002d9a85 (MD5) / Made available in DSpace on 2016-02-23T13:21:58Z (GMT). No. of bitstreams: 1 bienert_irc_dr_bot.pdf: 2600270 bytes, checksum: 99be667aca0d1c9255e8b1f9002d9a85 (MD5) Previous issue date: 2016-01-26 / Introdução: A cardiologia intervencionista requer necessariamente um acesso vascular invasivo, sendo esta via de acesso uma escolha do médico operador. Nesta escolha interfere o tipo de procedimento, impacto ao paciente, risco ao profissional e experiência técnica. O acesso via artéria femoral é o mais difundido globalmente e a técnica de acesso pela artéria radial tem sido progressivamente adotada devido ao maior conforto para o paciente, menores taxas de complicações e em alguns cenários, de mortalidade. Um dos focos de interesse crescente é a exposição à radiação ionizante e medidas para minimizar o risco ao paciente e ao profissional. Escassa é a literatura disponível na área e conflitantes são seus resultados. Objetivo: Avaliar os níveis de radiação recebidos pelo médico operador de acordo com as diferentes técnicas de acesso, bem como mapear áreas de escape de radiação. Após essa etapa, o estudo visou desenvolver e validar dispositivo de radioproteção dedicado à técnica radial (TRIPTable) voltado à redução da radiação ao médico operador, comparando o seu impacto à técnica femoral e radial padrão no cenário de pacientes portadores de síndrome coronária aguda randomicamente alocados para cateterismo com intenção de tratamento percutâneo. Métodos: A fase inicial pré-clínica do estudo foi constituída de avaliação em ambiente controlado dos níveis de radiação em pontos pré-especificados de um operador simulado com phantom de água. A fase clínica do estudo foi um ensaio clínico prospectivo, randomizado, unicêntrico, comparativo entre três grupos denominados técnica femoral, técnica radial e técnica radial com dispositivo radioprotetor TRIPTable, recrutados no Hospital das Clínicas de Marília (Marília/SP) e randomizados na proporção 1:1:1 (108 pacientes - 36 por grupo) avaliando a radiação recebida pelo operador em três diferentes pontos (gônadas, tireoide e olhos). Os resultados foram comparados com o grupo controle de 108 pacientes provenientes de coorte randomizada externa entre técnica radial e femoral 1:1, utilizando critérios similares, porém com operadores cegos aos objetivos de avaliação de radiação visando detecção de vieses de técnica (efeito Hawthorne) e validação de resultados. Resultados: Não houve diferença entre o estudo e a coorte externa ou entre os grupos do estudo quanto a características clínicas, desfechos dos procedimentos ou parâmetros de exposição radiológica ao paciente. Os resultados indicam maior radiação recebida pelo operador com a técnica radial (12,5 mSv), seguida da femoral (10,1 mSv) e TRIPTable (6,8 mSv). Em relação aos locais de exposição, o território de gônadas teve maior sensibilidade radiológica com uso da técnica radial (p=0,001). Com uso da técnica femoral não houve diferença entre os três territórios (p=0,398), porém na análise ad hoc o território de gônadas foi mais sensível quando comparado à exposição aos olhos (p=0,016) e limítrofe em comparação à tireoide (p=0,056). No grupo do dispositivo TRIPTable não houve diferença significativa entre qualquer um dos territórios analisados (p=0,180). Conclusões: O estudo indica equivalência entre os resultados do procedimento entre os grupos e quanto à exposição radiológica ao paciente. Contudo, demonstrou maior impacto radiológico para o operador que utilizou a técnica radial, em comparação à técnica femoral e à técnica radial com uso do dispositivo TRIPTable. O uso do dispositivo reduziu o impacto radiológico comparado ainda à técnica femoral. Tais diferenças derivaram primordialmente da variação em território de gônadas. Os achados demonstram um campo de exposição radiológica heterogêneo ao corpo do operador, benefício do dispositivo testado e oportunidade de novas formas de desenvolvimento de medidas de radioproteção. Registros: UTN/OMS - U1111-1158-8591 Plataforma Brasil - CAAE 32767514.0.1001.5413 Clinical Trials - NCT 02200783. / Background: Interventional cardiology requires an invasive vascular access, a choice of medical operator. This choice is affected by type of procedure, patient impact, professional risk and technical experience. Interventional procedures via radial technique have progressively increased due to improved patient comfort, lower complication rates, and reduced mortality in some scenarios. One area of interest is radiation exposure and ways to minimizing it. Most studies focusing on patient radiation risk demonstrated conflicting results, and there is no consensus for increased exposure with any technique. Objective: The aim of this study was to evaluate radiological exposure under controlled radial and femoral access simulation tests, mapping radiation paths. After this stage, the study developed a radiological protection device for the transradial technique (TRIPTable), comparing its impact as compared to standard femoral and radial techniques in the setting of patients with acute coronary syndrome randomly assigned for catheterization with intent to percutaneous treatment. Methods: Radiation exposure was simulated under controlled conditions for femoral and radial techniques using a pressurized ionization chamber and water phantom. Different measurement points were defined according to standard positions to simulate radiation received by the operator in the gonads, thyroid, and eyes at different angles during real procedures. The clinical phase of the study is a prospective clinical trial, single-center, randomized, and comparing three groups (femoral technique, radial technique, and radial technique with radioprotective device), admitted in the Emergency Department of Hospital das Clinicas de Marilia (Marilia / SP – Brazil). Patients were randomized in a 1:1:1 proportion (108 patients - 36 per group) evaluating the radiation received by the operator measured by dosimetry at three different points (gonads, thyroid and eyes). As it is impossible to blind operators to study techniques, the results were compared to an external control cohort of patients including 108 individuals with similar inclusion and exclusion criteria, randomized for radial and femoral technique, but with blinded operators to radiation objectives, aiming technical bias detection (Hawthorne effect) and validation of results. Results: There was no difference between groups regarding clinical characteristics, procedures or patient radiation exposure outcomes. The results indicate higher radiation received by the operator with the radial technique (12.5 mSv) as compared to femoral technique (10.1 mSv) and TRIPTable technique (6.8 mSv). Regarding exposure locations, the gonad region had a higher radiation sensitivity with radial technique (p=0.001). With femoral technique there was no difference between the three territories (p=0.398) but the ad hoc analysis indicated higher radiosensibility in gonads when compared to eyes exposure (p=0.016) and borderline compared to thyroid exposure (p=0.056). In the TRIPTable device group there was no significant difference between any of the territories analyzed (p=0.180). Conclusions: The study indicates no difference of radiation exposure to the patients between the groups. However, there was a greater radiologic impact to the operator who used the radial technique, compared to the femoral technique and TRIPTable device technique. The device reduced the radiological impact even compared to the femoral technique. Such differences derived primarily from variation in gonads exposure. The findings demonstrate a heterogeneous radiation exposure to the operator body, device benefit and an opportunity to develop new ways to improve radiation protection. Registration: UTN/OMS - U1111-1158-8591 Plataforma Brasil - CAAE 32767514.0.1001.5413 Clinical Trials - NCT 02200783.

Submitted by TATIANE ROBERTA FERNANDES TEIXEIRA null (tatianebt@ig.com.br) on 2016-04-27T14:10:26Z No. of bitstreams: 1 mestrado final 2016.pdf: 2224865 bytes, checksum: 8f91df194587a0744ed8ece2327c6d46 (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-04-29T18:54:48Z (GMT) No. of bitstreams: 1 teixeira_trf_me_bot.pdf: 2224865 bytes, checksum: 8f91df194587a0744ed8ece2327c6d46 (MD5) / Made available in DSpace on 2016-04-29T18:54:48Z (GMT). No. of bitstreams: 1 teixeira_trf_me_bot.pdf: 2224865 bytes, checksum: 8f91df194587a0744ed8ece2327c6d46 (MD5) Previous issue date: 2016-02-29 / A Organização Mundial da Saúde classificou as doenças cardiovasculares como as principais causas de mortes no mundo, responsáveis por altas taxas de internação e elevados custos hospitalares. A expressividade desses valores tem elevado os investimentos das técnicas e tecnologias utilizadas na elucidação diagnóstica e terapêuticas eficazes com intenção do controle dessas doenças. Esses avanços contribuem para o aprimoramento de estudos realizados em laboratórios de hemodinâmica como o cateterismo cardíaco. Esse exame, considerado padrão ouro no diagnóstico das obstruções coronárias, tem cerca de 80% dos procedimentos ambulatoriais, com a vantagem da redução do tempo de permanência no hospital e a desvantagem de diminuir o tempo de contato com a equipe, contribuindo para falhas na comunicação e interferindo na percepção dos profissionais no que se refere as necessidades e sentimentos do usuário em relação ao procedimento. Diante do exposto, este estudo tem por objetivo compreender o significado e descrever as informações recebidas sobre o cateterismo cardíaco aos usuários de um serviço de hemodinâmica, com vistas a elaborar orientações de enfermagem no pré-procedimento. É um estudo descritivo com abordagem qualitativa, que foi realizado no setor de hemodinâmica, de um Hospital de Ensino do Interior do Estado de São Paulo. Participaram do estudo 31 pacientes adultos que, pela primeira vez, estavam em procedimento de cateterismo cardíaco eletivo os quais aceitaram participar, assinando o Termo de Consentimento Livre e Esclarecido. Os dados foram coletados por meio de entrevista semiestruturada, realizada pela pesquisadora e a análise dos dados foi realizada pelo método de Análise de Conteúdo. Dos discursos dos entrevistados emergiram as seguintes categorias: os usuários conseguem relatar os sintomas e a trajetória que os levaram à realização do cateterismo cardíaco; as informações para o procedimento de cateterismo cardíaco são fornecidas na forma escrita, porém parcialmente assimiladas pelos usuários; os usuários desconhecem o procedimento de cateterismo cardíaco; a realização do cateterismo cardíaco mobiliza sentimentos de ansiedade e os usuários têm esperança de que o cateterismo cardíaco promova mudanças que melhorem a qualidade de vida. Os resultados do estudo permitem concluir que os usuários demonstram conhecimento insatisfatório acerca do cateterismo cardíaco e que as informações recebidas são parcialmente assimiladas, evidenciando a importância da equipe investir em capacitação comunicativa e no planejamento de orientações que fortaleçam os indivíduos na promoção da saúde, esperança e autonomia, além de estimular o reconhecimento das ações de Enfermagem. / The World Health Organization ranked cardiovascular diseases as the leading cause of death worldwide, being responsible for high rates of hospitalization and high hospital costs. These remarkable values have led to high investments in techniques and technology used in laboratory diagnosis and effective treatment in order to control these diseases. These advances contribute to the improvement of studies in hemodynamic laboratories, such as cardiac catheterization. This exam, considered gold standard in the diagnosis of coronary obstructions, amounts to about 80 % of outpatient procedures, with the advantage of reducing the patient's stay in hospital and the disadvantage of reducing the contact time with the team, contributing to failures in communication, and thus interfering with the staff’s perception of the user’s needs and feelings about the procedure. Given the above, this study aims to understand the meaning and describe the information received by the users of a hemodynamic service about the cardiac catheterization in order to prepare pre-procedure nursing guidelines. It is a descriptive qualitative study, which was conducted in the hemodynamic sector of a school hospital in São Paulo State. The study included 31 adult first-time patients who were under elective cardiac catheterization procedure and agreed to participate by signing the Instrument of Consent. Data were collected through a semi-structured interview, conducted by the researcher and data analysis was performed by the content analysis method. From the interviews the following categories emerged: users can report symptoms and the path that led to cardiac catheterization; the information for the cardiac catheterization procedure is provided in written form, but partially assimilated by users; users are unaware of the cardiac catheterization procedure; the cardiac catheterization mobilizes feelings of anxiety and users hope that the cardiac catheterization may promote changes which will improve their quality of life. The study results support the conclusion that the patients have poor knowledge about cardiac catheterization and the received information is partially assimilated, showing the importance for the staff to invest in communication training and planning guidelines which can reinforce individuals in health promotion, hope and autonomy in addition to stimulate the recognition of Nursing actions.