Thesis (Ph.D.)--York University, 2008. Graduate Programme in Psychology. / Typescript. Includes bibliographical references (leaves 99-127). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:NR51759

Thesis (M.S.)--West Virginia University, 1999. / Title from document title page. Document formatted into pages; contains vi, 110 p. : ill. (some col.) Includes abstract. Includes bibliographical references (p. 66-68).

Thesis (M.S.)--University of Michigan, 1994. / Includes bibliographical references.

Thesis (Ph. D.)--University of Washington, 1994. / Vita. Includes bibliographical references (leaves [159]-165).

Thesis (M.S.)--University of Michigan, 1994. / Includes bibliographical references.

Thesis PlanB (M.S.)--University of Wisconsin--Stout, 2006. / Includes bibliographical references.

The implantable cardioverter defibrillator (ICD) is a small medical device, implanted underneath the collarbone with wires leading from it to the heart. The device detects and terminates ventricular arrhythmias by delivering an electric shock, that otherwise would most likely lead to sudden cardiac arrest and sudden cardiac death. The ICD is perceived as the 'gold standard' treatment therapy for patients at risk of sudden cardiac death resulting from fast electrical rhythms (Bleasdale, Ruskin, O'Callaghan, 2005). However, ICD recipients have reported high levels of psychological distress such as anxiety and depression and a reduced quality of life (e.g. clinical review by Sears, Matchett & Conti, 2009). This thesis describes the development of a brief psychological intervention for patients living with an ICD based on the Medical Research Council's (2008) guidelines. The first stage in the development of the intervention was a qualitative study. Thirtysix ICD participants (ICD patients and partner) were recruited in south Wales. Semistructured interviews were conducted with each participant separately. Thirteen of the patients had not experienced an ICD shock. Transcripts were analysed by thematic analysis (Braun and Clarke, 2006) using a cognitive-emotional-coping framework. General findings revealed patients did not know how to regain normality after their ICD and highlighted common worries were identified. Accordingly, the intervention aimed to be a structured guide underpinned by cognitive behavioural theory. It aimed to address common worries and bridge the gap between hospital discharge and patient's 6-week follow up appointment. The intervention was tested using a pilot randomised control trial. Ninety-nine participants were randomised to an intervention or control group. Differences between groups at baseline were adjusted by analysis of covariance (ANCOVA) to control for differences at 3- and 6-months. Results revealed the intervention group reported improved levels of depression, increased levels of mild exercise and increased patient acceptance to the ICD compared to the control group at 6-months. The simplicity and cost-effectiveness of this intervention suggests that not only is it theory and evidenced based, but should be sustainable long term. The next stage would be to carry out a fully powered randomised control trial.

Class of 2011 Abstract / OBJECTIVES: To determine the availability of AEDs in Tucson weight rooms and fitness centers. This study also examined the prevalence of use of AEDs in facilities that report having one on site. METHODS: Weight rooms and fitness centers containing weight-bearing equipment in the major metropolitan area of Tucson were telephoned to partake in a questionnaire. The researchers asked for a manager to partake in the questionnaire at the time the call was made. Collected information included the presence of an AED, the use of the AED in the past year, frequency of AED testing to ensure proper function of the device, and the acquisition of gym member health history. RESULTS: A total of 68 weight rooms were called, and 9 numbers had been disconnected or were no longer in service. Thirteen had not responded after 3 attempts therefore, a total of 46 weight rooms were reached. Eighteen weight rooms had AEDs (39%), 22 weight rooms did not have an AED (48%) and 6 weight rooms declined to answer the questionnaire (13%). Exactly half of the 46 weight rooms gathered medical history from their members. Of the 18 weight rooms with AEDs, 14 affirmed that it was tested to make sure it worked. Test frequency ranged from daily to yearly with half (7 weight rooms) testing monthly. Only one weight room reported that their AED had been used before. CONCLUSION: Less than half of the weight rooms had AEDs on site. It was hypothesized that 70% of the weight rooms would have an AED. Therefore, the hypothesis about the prevalence of AEDs in Tucson weight rooms was incorrect. In contrast, the hypothesis about how many weight rooms have used their AED was correct; less than 10% of the weight rooms with AEDs had used one in the past year.

The effect of CRT on incidence of AF development in patients with severe HF was explored by comparing 36 patients with conventional indication for the CRT to 36 HF patients without CRT, matched for age, sex and LV systolic function (Publication 5). After a follow up of 3 years, the annual incidence of AF in the CRT group was 2.8%, which was significantly lower than the control group (10.2%). Moreover, the echocardiographic benefit by CRT was compared between these 36 patients with SR and 15 patients with persistent AF. The results showed that the echocardiographic response was similar between the two groups. These findings suggested that CRT may have the potential to reduce AF burden in patients with severe HF and that patients with persistent AF may also benefit from CRT. / The objective of the study (Publication 1) was to assess the feasibility of using non-contact LV mapping to delineate the LV endocardial activation pattern in 7 HF patients in NYHA class III, with low LVEF and wide QRS complex (>120ms). Non-contact mapping was safely performed and there were two endocardial conduction patterns identified, namely homogenous (Type I) and conduction block (Type II). The second part of the study (Publication 2) was to determine the implication of these two distinct activation patterns to echocardiographic and clinical response to CRT. 23 patients in NYHA class III, with LVEF <35% and QRS duration >120ms were recruited in this study. 15 patients had Type II pattern and 8 Type I. The QRS duration between the two types of conduction patterns were comparable. Patients with Type II pattern had a more favourable echocardiographic and clinical response to CRT than those with Type I. It was concluded that, despite the similar QRS duration between the two types of LV endocardial activation patterns, patients with Type II pattern had a more favourable response to CRT. / The significance of baseline renal function in CRT was assessed in 85 consecutive patients with conventional indication for the CRT (Publication 7). There was no significant relationship between baseline renal function and significant LV reverse remodeling after CRT, suggesting baseline renal insufficiency probably would not affect the response to CRT. (Abstract shortened by UMI.) / This study (Publication 3) was to determine the effect of CRT in patients with narrow QRS complex and evidence of mechanical dyssynchrony as determined by TDI. 51 patients in NYHA class III or IV, with LV ejection fraction <35%, and QRS duration <120ms were recruited for the CRT. The effect of the device therapy on LV systolic function in this cohort was compared to 51 patients who fulfilled the current criteria with wide QRS complex. CRT significantly improved the LV systolic function, NYHA class and exercise capacity in those with narrow complex to a similar extent in those with wide complex. With co-existing mechanical dyssynchrony determined by TDI, patients in both narrow and wide QRS complex groups showed more favourable response to CRT than those without significant mechanical dyssynchrony. This confirmed that QRS was a poor marker of mechanical dyssynchrony and the current selection criteria are probably not adequate to include more potential responders to the therapy. / This study (Publication 4) was to determine the role of optimal medical therapy in CRT recipients before implantation. The echocardiographic and clinical effect of CRT in 30 patients without the optimal combination of ACEi or ARB and beta-blockers was compared to 30 patients matched for age, sex, NYHA class and HF etiology. Patients with optimal medical therapy had significantly better echocardiographic and clinical response to CRT. The results confirmed that optimal medical therapy is necessary to achieve maximal response by CRT. / This study (Publication 6) was to determine if patients with moderate LV systolic function and wide QRS complex would benefit from the CRT. Significant improvement in LV systolic function was observed in 15 patients with LVEF between 35 and 45%, NYHA class III and QRS duration >120ms after CRT, suggesting that presence of LV systolic dysfunction and cardiac dyssynchrony may be the major determining factors for favourable CRT response. Therefore, patients with less advanced HF may also benefit from the CRT. / "May 2007." / Adviser: Yu Cheuk Man. / Source: Dissertation Abstracts International, Volume: 69-08, Section: B, page: 4657. / Thesis (M.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (p. 133-151). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / School code: 1307.

published_or_final_version / abstract / Electrical and Electronic Engineering / Doctoral / Doctor of Philosophy