No description available.

No description available.

Purpose: The primary purpose of this study was to determine if a pedometer-driven physical activity (PA) intervention with individualized stepcount goals would be more efficacious in yielding greater amounts of PA than the usual time-based PA recommendations given to maintenance CR patients. Additionally, the secondary purpose of this study was to assess differences in stepcount activity on days attending maintenance CR and on non-rehab days. Methods: Subjects entering maintenance CR for the first referral were recruited for study participation and stratified into pedometer feedback (PF) and usual care (UC) groups. All subjects wore a New Lifestyles NL-1000 pedometer. PF subjects wore the pedometer for the duration of the 8-week study. For comparison, UC subjects wore the pedometer at baseline, week 4, and week 8.Both groups were encouraged to accumulate a minimum of 40 - 50 min/d at moderate intensity when attending maintenance CR. UC subjects were encouraged to follow-up with at least 30 min/d PA outside maintenance CR, while PF subjects were given daily stepcount goals. Stepcount goals were calculated as 10% of baseline stepcounts and added weekly to increase daily goal. All subjects completed a 6- minute walk test at baseline and week 8, and behavioral change questionnaires were completed at baseline, week 4, and week 8. Results: A total of 18 subjects (PF, n = 9, 53.7±8.0; UC, n = 9, 60.2±9.6 yrs) completed the 8-week study. There were no differences between groups at baseline. PF group increased daily stepcounts by week 4 (19%, 1,080±649 steps/d) and 8 (44%, 2,468±846 steps/d) in addition to days attending rehab by week 4 (14%, 1064±45 steps/d) and 8 (36%, 2,711±423 steps/d) and non-rehab days by week 8 (42%, 1,747±759 steps/d). PF subjects accumulated greater daily stepcounts compared to UC subjects at weeks 4 (26%, 1,405±393 steps/d) and 8 (48%, 2,612±284 steps/d). UC subjects accumulated greater stepcounts on rehab compared to non-rehab days, but no changes were found from baseline for daily stepcounts, rehab, or non-rehab days. There was a time effect for responses to social support from friends for all subjects (baseline to week 4) and a time by group effect for decision balance pro-questions by week 4 where PF significantly increased, UC significantly decreased, and both groups where significantly different. Conclusions: The results of this study suggest that a pedometer-driven PA intervention yields significantly greater stepcounts compared to time-based PA recommendations among maintenance CR patients. / School of Physical Education, Sport, and Exercise Science

Clinically, the modified Bruce protocol is widely used to predict functional capacity in cardiac patients. However, it has been suggested that cardiac patients have lower oxygen uptakes for standard workloads. In order to study this, we measured oxygen uptake (V02) and venous bloodV02 derived from lactic acid concentration during a modified Bruce treadmill protocol in 12 pest myocardial infarction (MI) and 12 normal males. During three stages of the protocol mean oxygen uptake was significantly lower (1.42 - 6.2 ml/kg.min; p < .001) for the pest MI than the normal males.However, venous blood lactic acid concentrations were not different at these stages. The MI patients' measured V02 for three stages of the protocol ranged from 1.8 - 7.3 ml/kg.min lower than the Bruce predictions for cardiacs. In addition, measured V02 (max) for cardiac patients were from 3.68 to 11.15 ml/kg.min lower than the predicted the normal subjects. These data suggest myocardial damage may slow oxygen kinetics and results in lower actual V02during treadmill testing. However, blood lactic acid concentrations failed to demonstrate an anaerobic compensation for the lower V02 in pest MI patients.

M.Cur. (Intensive General Nursing) / The rehabilitation of the coronary artery bypass patient should be a continuation of the contact which exists during the hospitalisation phase, with specific reference to the pre-dismissal phase. As a member of the health team, the nurse makes the most important inputs during this phase because she is the one who is in constant contact with the patient and his family. The purpose of this study is to determine, by means of set criteria and within a nursing perspective, the contributions that are made by various support groups to the rehabilitation of persons who have undergone coronary artery bypass surgery.

This study was designed to elicit women's perceptions of their illness experience with myocardial infarction for the purpose of exploring and describing the nature and meaning of this illness experience and its impact on everyday life. The phenomenological method, a type of qualitative research, was used to direct the study. The data were compiled through a series of semi-structured intensive interviews with eight women. The women were 36 to 71 years of age. Six of the women were married and living with their husbands. The women had been at home following discharge from hospital for 2 to 14 weeks. Data collection and data analysis proceeded simultaneously and data collection ceased once consistent themes were identified and validated and the data collected were sufficiently rich and in-depth. Women explain their illness experience with myocardial infarction as a loss phenomenon and the central and dominant loss within the heart attack experience for women is loss of predictability. Women's need for information following myocardial infarction is not met and lack of energy is a prominent feature in everyday life after a heart attack. Traditional sex role socialization sets the stage for potential problems in women's cardiac rehabilitation, especially in relation to support and role enactment. Physical rehabilitation is not a selected strategy to gain control over their loss experience for women with myocardial infarction. The findings and conclusions of this study suggest a number of implications for nursing practice. There is clear direction for family-centered nursing care in the rehabilitation of women with myocardial infarction to address potential problems in relation to support and role enactment. This study reinforces the value of using the concepts of loss and grief to care for patients with myocardial infarction. Also, this study indicates that, in planning nursing care for women with myocardial infarction, nurses should focus on Interventions to increase support, to meet patient and family educational needs, and to help women to anticipate normal physical and psychological responses to myocardial infarction. This study also has specific implications for the development of structured cardiac rehabilitation programmes addressing the special needs of women. In relation to nursing education, nurses must be prepared to assess, teach, and counsel patients with myocardial infarction and their families. Most importantly, this study directs nursing educators to provide course work in women's health issues to sensitize nurses to this field of study and to equip nurses with the understanding necessary to facilitate changes in women's health care. Implications for future research include further exploration of information needs, support, and strategies for control in relation to women with myocardial infarction. / Applied Science, Faculty of / Nursing, School of / Graduate

This study evaluates the outcomes of a hospital-based cardiac rehabilitation program designed to deliver the first phase of cardiac rehabilitation services at home. The program was established in a community hospital in 1985, operating under the administration of the hospital's Medical Day Centre. Patients suffering from acute myocardial infarction (MI) are referred to the program by their physician and receive services from a cardiac nurse specialist immediately upon discharge. The services continue for a period of 6 weeks. The outcomes of importance in the study are the effects of the program on hospital services in the initial 10 month period and on patient's health related behaviour 3 months post infarction. Results of the study indicate that program goals were achieved during the initial 10 months of the study. Physicians referred 92% of the eligible patients and the average length of stay (ALOS) in hospital was satisfactorily reduced. For patients with uncomplicated MI the ALOS was 8.6 days by the tenth month. At 3 month follow up, patients reported significant improvements over their pre infarction health related behaviour. There were significant increases in the frequency of light exercise (p<-0005), in the regular use of low fat dairy products (p=.0003) and in the practice of restricting calories (p=.003) while significant decreases were reported in the frequency of consuming fried foods (p<.0005), salted foods (p<.0005) and rich foods (p<.005) and in the regular use of table salt (p=.00003). Smoking cessation was reported by 50% of the smokers at follow up. Patients reported a high level of satisfaction with the program, describing the service as well timed, informative, practical and valuable in restoring their self confidence. While these results were satisfactory with regards to the program goals, the evaluation was based on a single group design and further investigation is desirable with comparisons between hospitals and between patients with and without exposure to the program. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

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No description available.

Aim : The study was explored within the context of a survey to determine the need and scope for a cardiac rehabilitation programme at Grey’s Hospital in Kwa Zulu-Natal. A multi-disciplinary perspective was sought as a cardiac rehabilitation programme with a multi-disciplinary approach is holistic. Also it is an effective intervention as secondary prevention in the care of the cardiac patient. Design : Exploratory survey in a “case-study”. Setting : a provincial, tertiary hospital in Kwa-Zulu Natal Participants : Permanent healthcare workers employed by the Department of health and working in the various units at Grey’s Hospital with more than 3 years experience. Staff included nurses and doctors in the coronary care unit, medical ward D1, catheterization unit and the cardiac clinic. Allied staff such as occupational therapists, dieticians, psychologists and physiotherapists also participated in this study. Staff not satisfying the above criteria and those not consenting to be part of the study were excluded. 58 questionnaires were distributed and 35 were returned completed. Intervention : A self developed questionnaire was used and information was obtained about the demographics of the healthcare workers, relevant interaction with cardiac patients and aspects of training related to cardiac conditions. Questions were directed to professionals as pertained to their respective scope of practice. Some questions were “open” ended and required responses with descriptions and/ or explanations. Admission records were perused in various cardiac units to determine the number of cardiac patients accessing services at Grey’s Hospital. Results : The total number of cardiac patients that attended Grey’s Hospital from January 2007 to December 2011 was 19983. The cardiac clinic showed an increase annually in the number of patients each year from 2495 in 2007 to 3569 in 2011 with a total number of 15928 over 5 years. All professionals assisted patients with achieving cardiac rehabilitation goals. There was a need demonstrated for the implementation of written resources for patient education; and training of staff in cardiac rehabilitation according to international guidelines. Basic life support (CPR) training is present among some professionals. A structured referral of patients for cardiac rehabilitation is not present and a phase I-IV cardiac rehabilitation programme with updated protocols is not present at Grey’s Hospital. Health professionals listed the scope of practice for current and potential interventions with cardiac patients. Healthcare workers also expressed their views on the value of a multi-disciplinary cardiac rehabilitation programme at Grey’s Hospital. Benefits for a multi-disciplinary cardiac rehabilitation programme at referral hospitals were listed by the multi-disciplinary healthcare workers. It was found there is a strong agreement to have a cardiac rehabilitation programme at Grey’s Hospital across all disciplines. An overall agreement of 32/35 for rehabilitation programme is statistically significant with p < 0.001. Conclusion : There is a need for a multi-disciplinary cardiac rehabilitation programme at Grey’s Hospital. / Thesis (M.Physio.)-University of KwaZulu-Natal, Durban 2012.