Heart failure (HF) hospital readmission reductions are linked to nursing interventions that include scheduling a hospital follow-up appointment with the patient's health care provider within a week of discharge. Yet, patients often leave the hospital without an appointment scheduled. The focus of this integrative literature review was on analyzing data that associated follow-up within 7 days with reduced 30-day readmissions. A search of articles using CINAHL, MEDLINE, Cochrane Database of Systematic Reviews, and ProQuest databases resulted in 4,813 articles retrieved using the following search terms: heart failure, readmissions, follow-up appointments, and heart failure guidelines. Scholarly articles selected for inclusion were published between January 1, 2007, and June 30, 2017, in the English language, regarding studies completed in the United States, available online in full text, and specific to patients with HF. The Melnyk Critical Appraisal Guide was used for the appraisal, evaluation, and synthesis of the evidence. The transitional care model served as the theoretical framework for the project. A key finding of the review was that follow-up appointment scheduling within 7 days was associated with a modest reduction in readmissions; more research is needed to produce additional evidence on this topic. Project dissemination may result in positive social change by raising awareness of health disparities and empowering patients and staff to work collaboratively. Through improved communication and follow-up between patients and the interdisciplinary team, patients with HF may be able to experience improved disease management and a reduced number of hospitalizations.

This thesis consists of a collection of poems: two thematic-translations that engage source material for their composition and two anaphoric poems. “A Seeson in Heckk,” an epyllion (or mini-epic), engages Arthur Rimbaud's "A Season in Hell," as it echoes his syntax and translates some of his themes into a portrait of a troubled young speaker familiar but strange to Rimbaud's. “Love Poem,” the first anaphoric poem in the collection, explores the arc of a relationship through surreal, bizarre, and lyrical images that chart the experience of falling in and out of a tumultuous love affair. “THE BOOK OF CLAY” is composed in relation to “The Narrative of the Captivity and the Restoration of Mrs. Mary Rowlandson.” These poems form a surreal, pastiche, thematic-translation of the early American's accounts of her experience during the King Philip's War. “Transplant: Final Lines from a Poem Titled, Cardiology” also uses anaphora, while it explores emotional identity, authenticity, and an overused poetic trope: the heart.

Indiana University-Purdue University Indianapolis (IUPUI) / Autonomic control of the heart results in variations in the intervals between heart beats, known as heart rate variability. One of the defining components of autonomic control is the baroreflex, a negative feedback controller that balances heart rate and blood pressure. The baroreflex is under constant command from the branches of the autonomic nervous system. To better understand how the autonomic nervous system commands the baroreflex, a baroreflex reflexogenic animal protocol was carried out. Heart rate variability analysis and baroreflex sensitivity were used to quantify the neural control of the heart. This thesis reconfirmed the existence of sexually dimorphic properties in the baroreflex through the use of heart rate variability analysis and baroreflex sensitivity. It was discovered that there are many caveats to utilizing heart rate variability analysis, which have to be addressed both in the experimental protocol and the signal processing technique. Furthermore, it was suggested that the slope method for quantifying baroreflex sensitivity also has many caveats, and that other baroreflex sensitivity methods are likely more optimal for quantifying sustained activation of the baroreflex. By utilizing various heart rate variability signal processing algorithms to assess autonomic tone in Sprague-Dawley rats during rest and sustained electrical activation of the baroreflex, the null hypothesis was rejected.

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

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Women are thought to be under-represented as clinical trial participants and as clinical trialists in heart failure. We reviewed randomized controlled trials of heart failure published in high impact medical journals and examined the representation of women as both participants and authors. Furthermore, we explored clinical trial characteristics independently associated with women as clinical trial participants and as lead authors. Our analysis demonstrated that women are under-represented as both clinical trial participants and leaders, with no change in temporal trends over time. Addressing clinical trial characteristics associated with under-representation and developing strategies to overcome barriers may be a strategic way to improve the representation of women in heart failure research. / Thesis / Master of Science (MSc)

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