A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Doctor of Philosophy Johannesburg, 1998 / Coronary heart disease (CHD) is the most common cause of death in the western world (Roberts, 1992). A high incidence of CHD is also reported for the White and the Asian population of South Africa (Wyndham, 1979). Coronary artery bypass graft (CABG) SL ~..;ry continues to be a proven, effective therapy to relieve symptoms of angina, to improve the patient's quality of life and to prolong life in selected patients (Connolly and Guyton, 1992). This intervention is costly and the operative success of coronary revascularization is limited unless the patient understands and will adhere to the prescribed medical regimen, diet and exercise after surgery (Marshall et al, 1986). The problem is compounded as post-operatively, the symptoms of coronary artery disease are ameliorated and the patient may be unaware of the persistence of the disease process. In additlon, the World Health Organisation's definition of cardiac rehabilitation, puts (olward the concept that the patient must accept responsibility for his or her own recovery (Oldridge, 1986). The role that the patient plays post-operatively must therefore become important in the final outcome. In 1977 Ginzberg wrote: "No improvement in the health care system will be efficacious unless the citizen assumes responsibility k~ his/her own well-being", This statement implies that people must take charge of their own health and not abrogate this responsibility to the experts. This study was designed to determine whether the acceptance of selfresponsibility is all important determinant of the successful outcome of corollary artery bypass graft (CABG) surgery. The final study was preceded by five pilot studies to assist in formulating and identifying the concept of selfresponsibility. Questionnaires were designed to determine aspects of improved quality of life and self-responsibility. For the final study. 75 patients who had undergone CABG surgery, were selected from surgical patients in the private as well as the public sector. In order to assess the acceptance of self-responsibility, the spouses/care-givers of the patients were included in this study. Patients were interviewed 4 to 6 days after the operation, and again six months and 12 months later. Successful outcome was measured in terms of improved quality of life using the criteria suggested by the Coronary Artery Surgery Study (Coronary Artery Surgical Study Principal Investigators, 1983). Tine acceptance of self-responsibility was then investigated as a possible factor influencing the improvement of the quality of life of these patients .. It was found that the acceptance of self-responsibility for the successful outcome of CABG surgery was a significant factor in the group of patients with an improved quality of life (p<0.01). From the results of this study, a profile of South African patients with improved quality of life was identified. They are: Men, married, annual income> R50 000 (US $8 000), who had a normal sex-life prior to the operation. They differ significantly from the group without an improved quality of life in the following aspects: they had spent more hours participatinp in sport at school (p=0.04), had stopped their sporting activities for a shorter period of time prior to the operation (p<0.01) and were taller (p<O.01). They were not depressed 12 months after the operation (p<0.01). Patients who accept self-responsibility for their recovery after CABG surgery have the following characteristics: married (p<0.01), have a level of education> grade 12 (p=O.01), have an annual income: R50 000 (p=O.05). They differ from the group who are not responsible in that they and their spouses/care-givers have more knowledge about the disease and the risk factor modification (p=O.01; p<O.01), and twelve months after the operation the patients are satisfied with the outcome of the operation (p<0.01). A stepwise logistic regression established that the acceptance of selfresponsibility was the strongest predictive fsctor for an improved quality of life after CABG surqe.,: Patients who did not accept responsibility would not have an improved quality of life irrespective of the impact of all other parameters. Patients' satisfaction with the outcome of the operative procedure is an important predictor of the acceptance of self-responsibility. Realistic expectations of the outcome of CABG surgery will improve pati-mts' satisfaction with the outcome ..The knowledge of the spouse is a significant factor in the patients' acceptance of self-responsibility. The spouse of a patient is frequently neglected by health- care workers and yet this person is very important for the patient's successful lifestyle change. Knowledge of the chronic nature of their disease as well as risk factor modification and realistic expectations of the outcome of CABG surgery influences patients' acceptance of self-responsibility. Every effort should be made to assist patients in accepting the responsibility for their own recovery so that the outcome of CABG will be successful. / MT2017

Thesis (M.S.)--University of Michigan, 1986.

Thesis (M.S.)--University of Michigan, 1986.

Bakgrund: En kranskärlsoperation är ett behandlingsalternativ till dem som har en kranskärlssjukdom. Den utförs främst vid komplicerade fall och innebär att med nya kärl skapa en förbindelse förbi det förkalkade kranskärlet runt hjärtat. Operationen är stor och påfrestande, och innebär flera förändringar i livet.   Syfte: Syftet med denna litteraturstudie är att belysa patienters erfarenheter av att ha genomgått en kranskärlsoperation.   Metod: En litteraturstudie utfördes genom att granska 10 vetenskapliga kvalitativa studier som stödjer författarnas syfte. Studierna analyserades och sammanställdes till ett resultat.   Resultat: Operationen påverkade deltagarna och deras återhämtning på olika sätt. Besvärliga kroppsliga symtom kunde visa sig under återhämtningen. Många tankar och funderingar väcktes som skapade oro och rädsla. Stöd och information hade en betydande roll och operationen krävde livsstilsförändringar som kunde vara svåra att anpassa sig till.   Konklusion: Brist på information och avsaknad av länk till sjukhuset efter utskrivning, ledde till rädsla och oro vilket skapade en otrygghet. Ytterligare forskning om stöd och information behövs för att kunna hjälpa och tillfredsställa patienters behov.

No description available.

No description available.

This thesis explores the relationship between memory self-report, depression and neuropsychological performance at both baseline and six months following coronary artery bypass graft surgery (CABG). An additional important refinement on previous work included the adoption of a theoretically driven approach to calculate post-test change scores (Standardized Based Regression) in order to control measurement error, practice effects and regression-to-the-mean. A further important refinement included the analysis of different subtypes of depression and how they affect patient perceptions of memory over time. A prospective study of 64 elective CABG surgery patients (mean age 65.4 years) was undertaken pre-operatively and six months post-operatively, along with the assessment of 50 normal control participants (mean age 68.6 years). The neuropsychological test battery was selected in accordance with the Statement of Consensus on the Assessment of Neurobehavioural Outcomes after Cardiac Surgery (Murkin et al., 1995). Standardized self-report measures of depression and memory self-report were also included, namely the DASS and MAC-S. Unexpectedly, results showed that both CABG patients and controls scored in the 'normal' range for depression at both testing intervals. However, at baseline assessment, analyses showed small, significant correlations between memory self report and depression as well as between memory self-report and the CVLT variable Short Delay Free Recall. The depressive subscales of Inertia and Self-deprecation also emerged as significant predictors of memory self-report using hierarchical regression analysis. At follow-up assessment, no significant correlations were found between memory self report, depression or any neuropsychological variable. However, the DASS depression subscale of Devaluation of Life entered as a significant predictor of memory self-report. Collectively, these results provide little evidence of a relationship between subjective and objective measures of memory. However, they indicate that relatively non-depressed patients can show mild variants of the cognitive biases and symptoms classically related to clinical depression and that these symptoms correlate significantly with perceptions of memory. Although no consistent trends were found over time, excluding any inferences of causality, this study was the first to systematically examine the relationship between depressive symptoms and memory self-report, with a view to assisting clinicians to identify patients more inclined to over-report memory failure. / Thesis (PhD)--University of South Australia, 2006.

Coronary artery bypass grafting (CABG) is the most common cardiac surgical operation performed in western countries, and is also increasingly being performed in developing countries. However the long-term results of CABG using the saphenous vein graft have not been satisfactory. Surgeons have therefore been seeking a better conduit. The radial artery (RA) is a potentially suitable alternative conduit and has to date provided good early results. This thesis investigates the utility of the RA as a coronary artery bypass graft from a number of perspectives. It demonstrates the safety of RA harvesting by examining hand collateral circulation using anatomical dissection, physical examination using the modified Allen test, measuring digital blood pressure, and examining the flow velocity in the digital artery using Doppler ultrasound. Anatomical examinations revealed consistent continuity between the RA and ulnar artery in the hand through either superficial or deep palmar arches. The modified Allen test was found to be useful as a screening test compared with the Doppler dynamic test and digital blood pressure index. A histological comparison was made between pre-existing intimal disease in the RA compared with that in the standard conduit the internal thoracic artery (ITA). The RA showed a higher prevalence and degree of intimal disease than ITA. Risk factors for intimal hyperplasia in the RA were age, diabetes, smoking and peripheral vascular disease. The only predictor for medial calcification was age. (For complete abstract open document)

Diss. (sammanfattning) Uppsala : Univ., 2002. / Härtill 5 uppsatser.

Diss. (sammanfattning) Linköping : Univ., 2002. / Härtill 5 uppsatser.