No description available.

Congestive heart failure (CHF) is one of the leading causes of hospitalisation, morbidity and mortality in the UK. The incidence and prevalence of CHF is expected to increase due to the aging population and improved survival in heart disease. Exercise has been recognised as a valuable treatment and has proved to be beneficial in CHF. The present study applied the Theory of Planned Behaviour (TPB) and the Commonsense Model of Self-regulation to fitness, daily activity and medication-adherence in elderly patients with CHF. The study was in parallel with a randomised controlled trial of a 3-month exercise programme. A TPB questionnaire was used at baseline and at 3 months. Illness representations were assessed by IPQ-R at baseline. Fitness (measured by 6 minute walk test) and daily activity (measured by an accelerometer) were assessed at baseline, 3 and 6 months. ACEI-adherence (assessed by measuring serum ACE level) was assessed at baseline. The main findings from 81 CHF patients (mean age = 81 years) showed that Subjective norm (SN) was the only predictor of Intention (IN1) at baseline; Attitude, Perceived behavioural control (PBC) were predictors of INT at 3 months; fitness was predicted by PBC at 3 months. The exercise intervention led to significant changes in Attitude and PBe. The finding also indicated that the participants were more likely to attribute their illness to Chance, BiolOgical factors and God. Identity and Illness coherence predicted fitness, and Consequences predicted daily activity. Participants who believed that their illness was chronic or serious were less likely to adhere to ACEI medication. Conclusion: both the TPB and IPQ-R were useful instruments to predict behaviours in elderly patients with CHF. The IPQ-R had a greater predictive power than the TPB in this population. Illness representations may play a role in influencing the formation of intention as background factors.

published_or_final_version / Nursing Studies / Master / Master of Nursing

Patients with heart failure (HF) must monitor and recognize escalating symptoms to manage worsening HF in a timely manner. However, routine symptom monitoring is not commonly performed by this population. Providing a symptom diary along with an education and counseling session may help HF patients promote symptom monitoring and interpretation. The accumulated information about changes in daily symptoms will allow patients to easily compare current symptom status to the past without depending on memory and can rapidly capture worsening HF. To date, few studies have tested the effect of a daily symptom diary. The purpose of this dissertation was to develop and test a symptom diary intervention to improve outcomes in HF patients. Prior to testing the intervention, preliminary work included: (1) determining the impact of symptom clusters on cardiac event-free survival; (2) evaluating the quality of existing symptom measures designed for HF patients; (3) evaluating the effect of physical symptom items that were often included in a depressive symptom instrument on cardiac event-free survival; and (4) evaluating the association between symptom monitoring and self-care management. Based on this information, a randomized, controlled pilot study was conducted to test the effect of a symptom diary with an education and counseling intervention on prognosis, healthrelated quality of life (HRQOL), and self-care maintenance at 3 months follow-up. A total of 44 hospitalized patients with HF were randomly assigned to either usual care or intervention providing a daily symptom diary with education and counseling. There were trends toward fewer HF events and improved self-care maintenance in the intervention group compared to the usual care group. However, there was no difference in HRQOL between the two groups. The results of this dissertation suggest the importance of assessing symptom clusters and further studies to improve the quality of existing HF symptom measures. Results from this dissertation also provided the evidence of the advantages of regular symptom monitoring to facilitate early identification of worsening HF and initiation of timely responses. However, further studies are needed to provide additional evidence of the positive impact of a use of daily symptom diary in patients with HF.

No description available.

Cardiotoxicity associated with many cancer drugs is a critical issue facing physicians these days and a huge hurdle that must be overcome for a side effects-free cancer therapy. Survival of cardiac myocytes is compromised upon the exposure to certain chemotherapeutic drugs. Unfortunately, the mechanisms implicated in cardiac toxicity and the pathways governing myocyte survival are poorly understood. The following thesis addresses the mechanisms underlying the cardiotoxicity of two anticancer drugs, doxorubicin (DOX) and Imatinib mesylate (Gleevec). Transcription factor GATA-4, has recently emerged as an indispensable factor in the adult heart adaptive response and cardiomyocyte survival. Therefore, the specific aim of this project was to determine the role of GATA-4, its upstream regulators, as well as partners in survival. A combination of cell and molecular techniques done on in vivo, and ex vivo models were utilized to tackle these issues. In this study, we confirmed the cardiotoxicity of the anticancer drug, Imatinib mesylate and found to be age dependent. GATA-4, already known to be implicated in DOX-induced toxicity, was confirmed as an Imatinib target. At the molecular level, we identified IGF-1 and AKT as upstream regulators of GATA-4. Moreover, we confirmed ZFP260 (PEX-1), a key regulator of the cardiac hypertrophic response, as a GATA-4 collaborator in common prosurvival pathways. Collectively, these results provide new insights on the mechanisms underlying drug-induced cardiotoxicity and raise the exciting possibility that cancer drugs are negatively affecting the same prosurvival pathway(s), in which GATA-4 is a critical component. Therapeutic interventions aimed at enhancing GATA-4 activity may be interesting to consider in the context of treatments with anticancer drugs.

Heart failure (HF) is a chronic condition affecting older adults. It is estimated over 5.8 million Americans are currently diagnosed with HF, with an anticipated increase to seven million by 2030. HF patients are faced not only with the physical symptoms, but also with emotional tolls, and socioeconomic burdens related to HF. Low income and rural facilities, which lack financial resources, are at greater risk for closure if there are concerns of loss of reimbursement. Hospitals are now challenged to prevent readmissions and to avoid penalties associated with HF admission within the 30-day window. Incorporating various interventions have shown improvements in readmission rates. Nurse practitioners and registered nurses can serve as patient educators regarding topics such as diagnoses, procedures, disease monitoring, medications, and medication side effects. In most hospitals, RNs at patients' bedside are at the forefront of providing HF patients discharge instructions and education, which should include symptom recognition and management. The aim of this project inquiry was to assess the knowledge of HF education and perceived barriers to providing HF education by nurses and nurse practitioners, such that improved transition of care for patients in the rural health setting can occur.

Bakgrund:Hjärtsvikt är en sjukdom som blir vanligare vid stigande ålder och cirka 250 000 svenskar är drabbade (Hjärt-lungfonden, 2016). Patienter ska enligt Patientlagen (SFS 2014:821; SFS 1982:763) få information om sitt hälsotillstånd, vilka former av undersökningar, vilken vård som kan användas, förväntade behandlingsförlopp, riskerna och eftervård. Patienten får inte alltid nödvändig information. Bristen på information kan bero på allt från patientens okunskap till vårdgivarens tidsnöd på grund av hög arbetsbelastning. Syfte: Att undersöka sjuksköterskornas sätt att informera och olika perspektiv på innehållet på den information som förmedlas till patienter med hjärtsvikt på en kardiologisk slutenvårdsavdelning. Metod:En deskriptiv intervjustudie med kvalitativ ansats och innehållsanalys. Resultat: Resultat visar att den information som förmedlas till patienter med hjärtsvikt kan se olika ut beroende på vilken sjuksköterska som ger informationen. Slutsats:Informationen sjuksköterskor förmedlar till patienter med hjärtsvikt varierar beroende på patientens kunskap, hälsotillstånd, intresse och grad av kognitiv förmåga. Dock kan hög arbetsbelastning förhindra sjuksköterskan att ge individuellt anpassad information. / Background: Heart failure is a condition that becomes more common with age, and about 250 000 Swedes are affected (Heart-Lung Foundation, 2016). Patients should, under the Patient Act (SFS 2014: 821, SFS 1982: 763), obtain information on their health status, the types of treatment, what care may be used, the expected course of treatment, risks and aftercare. The patient does not always get the necessary information. The lack of information may depend on everything from the patient's lack of knowledge to the caregiver's shortage of time, because of the heavy workload. Aim: To investigate the nurses' ways of informing and different perspectives on the content of the information conveyed to patients with heart failure in a cardiologic healthcare department. Method: A descriptive interview study with qualitative approach and content analysis. Results: Results show that the information given to patients with heart failure may vary depending on the nurse who provides the information. Conclusion: The information nurses convey to patients with heart failure vary depending on the patient's knowledge, state of health, interest and degree of cognitive ability. However, high workload can prevent the nurse to provide personalised information.

Bakgrund: Hjärtsvikt är ett vanligt förekommande sjukdomstillstånd och diagnosen återfinns hos en kvarts miljon människor i Sverige. Behandlingen främjas av en personcentrerad omvårdnad med delaktighet och följsamhet hos den drabbade personen. Detta bygger på att sjuksköterskan ökar sin förståelse för personens unika situation. Syfte: Att beskriva personers upplevelser av att leva med hjärtsvikt Metod: En litteraturöversikt där 13 kvalitativa artiklar inkluderades. Resultat: Personer med hjärtsvikt upplever sig fysiskt begränsade av sin sjukdom. En försämring i både fysisk och psykisk hälsa visade sig. Resultatet redovisas i katergorierna; begränsningar i vardagen, förändringar i sinnesstämningen och förändringar i det sociala nätverket. Slutsats: Resultatet visar på en stor variation i upplevelserna hos personer drabbade av hjärtsvikt. Det är därför viktigt att sjuksköterskan har en bred kunskap och en omfattande förståelse för sjukdomen, då det främjar en individanpassad vård baserad på rådande förhållanden. Nyckelord: hjärtsvikt, personcentrerad omvårdad, upplevelser / Background: Heart failure is a common disease and the diagnosis is found in a quarter of a million people in Sweden. The treatment promoted by person-centered care with the participation and adherence of the affected person. This is based on that the nurse increase the understanding of the person's unique situation. Aim: To describe people's experiences of living with heart failure Methods: A literature review where thirteen qualitative articles were included. Results: People with heart failure feel physically limited by their disease. A deterioration in both the physical and mental health appeared. The results were divided into following main categories; limitations in everyday life, changes in mood and changes in the social network. Conclusion: It is important that the nurse has a broad knowledge and a comprehensive understanding of heart failure, when it showed a great variation in how people perceive their situation. This promotes an individualized care based on current conditions. Keywords: experiences, heart failure, person-centred care

Background: Heart failure (HF) is a complex, costly and debilitating chronic health condition. Symptom recognition and self-care are crucial components of heart failure management; however, many HF patients struggle to perform these behaviors and skills at a proficient level. A transitional care program in the Southwest provides services to heart failure patients. A primary program aim is to help facilitate enhanced symptom recognition and self-care among heart failure patients. This project focuses on the assessment of the impact of such a transitional care program on HF patients' ability to perform symptom recognition and self-care. Methods: Demographic questionnaires were distributed to collect socioeconomic data and clinical characteristics of participants. A pre and post SCHFI survey was completed by participants, and analysis of data performed using a paired t-test. Results: The 15 participants were primarily Hispanic, elderly, and male. The majority of participants reported an annual income less than $10,000, lived in close proximity to the transitional care clinic, reported living with family and/or friends, and had at least one additional comorbidity. There was improvement in self-care maintenance scores following the initial transitional care encounter; however, participants did not achieve self-care adequacy in this domain. Participants also did not achieve self-care adequacy in self-management. Self-confidence scores improved to reach adequacy following the initial transitional care encounter; however, results were not statistically significant. Conclusion: With the complexities of HF self-management, it is not alarming that these patients have continued to struggle with symptom recognition and self-care. Recommendations are made for future research and interventions.