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Thesis (D. Th. (Praktiese Teologie))--Universiteit van Suid-Afrika, 2002.

Submitted in partial fulfillment of the requirements for the degree of Master of Technology (Clinical Technology : Cardiology), Department of Clinical Technology, Durban University of Technology, Durban, South Africa, 2015. / Introduction Infective endocarditis is a serious disease that needs rapid diagnosis and accurate risk stratification to offer the best therapeutic strategy. Echocardiography plays a key role in the management of the disease but may be limited in some clinical situations. Moreover, this method is insensitive for very early detection of the infection and assessment of therapeutic response because it does not provide imaging at the molecular and cellular levels. Recently, several novel morphological, molecular and hybrid imaging modalities have been investigated in infective endocarditis and offer new perspectives for better management of the disease. Aims and Objectives of the Study This prospective, quantitative and observational study was investigated at Dr George Mukhari Hospital in Pretoria, South Africa. Infective Endocarditis is a serious disease associated with poor prognosis despite improvements in medical and surgical therapies. Infective Endocarditis results in complex pathogenesis that involves many host-pathogen interactions. Indeed, previous endocardial lesions can lead to the exposure of the underlying extracellular matrix proteins, local inflammation and then thrombus formation, which is termed ‘non-bacterial vegetation’. The project aims to compare the echocardiographic findings (transthoracic echocardiographic-TTE) with intraoperative findings on patients with infective endocarditis. If the correlation existed then the echocardiogram findings were accurate when performed in patients with infective endocarditis. Methodology The research participants consisted of forty (40) patients with infective endocarditis at Dr George Mukhari Hospital in Pretoria, South Africa. A cardiologist examined the patient’s clinically for features of infective endocarditis. Two techniques were used to assess the infective endocarditis. These included echocardiography and Intraoperative findings (visual and histology). Bloods were cultured to demonstrate the presence of micro-organisms. Blood was sent to the laboratory for culture in order to detect the presence of micro-organisms. The researcher performed an Echocardiogram to assess which valve was affected, the left ventricular endiastolic diameter (LVED), the left ventricular ensystolic diameter (LVES), the shortening fraction (SF), the ejection fraction (EF) and the size of the vegetation/mass or abscess. For patients requiring a heart surgery, the cardiac surgeon performed the valve replacement, and the intra-operative findings was assessed visually to confirm the presence of vegetation or abscess and leaflets destruction. During the operation, which was performed by the same cardiac surgeon, a biopsy sample was taken for histological examination to confirm the presence of vegetation or abscess. Thereafter, the cardiac surgeon performed the valve repair/ replacement/ bioprosthesis. The researcher was blinded to the findings in the theatre as the researcher was not present in the theatre. The results from the laboratory was sent to the researcher. The researcher was then able to confirm the presence of vegetation or mass/ abscess and leaf destruction. Results The histology confirmed what was seen on echocardiographical findings and intraoperative findings (visual). The intraoperative and echocardiography findings showed thirty two of 40 (80%) vegetation, two of 40 (5%) perforation, four of 40 (10%) pseudoaneursym and two of 40 (5%) abscesses. The prognosis of patients with poor ejection fraction (40-50% EF) was poorer than those with good ejection fraction (60-75%). The clinical findings of all patients confirmed infective endocarditis and thirty two of 40 (80%) blood cultures were positive and eight of 40 (20%) were negative. There were seven of 40 (17,5%) patients who showed poor correlation 40- 50% between echocardiographical findings and post-operative findings. The results of thirty three of 40 (82%) patients showed moderate correlation 69% between the echocardiographical findings and post-operative findings. Conclusion My findings of the study was that eight of 40 (20%) had stenosis and thirty two of 40 (80%) had regurgitation in patients who had infective endocarditis. There was an overall moderate association (r=0.68) between echocardiography and the intraoperative findings in all patients for LVES.

published_or_final_version / Community Medicine / Master / Master of Public Health

The purpose of this research was to describe the relationships among patient characteristics, care processes, and care outcomes for patients in a coronary care unit (CCU). The sample consisted of 179 CCU patients. Data collectors reviewed charts and retrieved the chart information needed to measure the operational variables of APACHE II score (Acute Physiology and Chronic Health Evaluation II), years of age, CCU length of stay, nurse to patient ratio, and mortality. Descriptive statistics were used to analyze the demographic data of the patient characteristics. Correlational statistics were used to analyze the five operational variables in the "CCU Patient Outcomes Model." Pearson correlations revealed significant positive relationships between APACHE II score and age and nurse to patient ratio. Point Biserial correlations revealed significant positive relationships between mortality and APACHE II score and nurse to patient ratio. Patient characteristics were related to care processes. Patient characteristics and care processes were related to patient outcomes.

The purpose of this study was to describe the relationship between health expectations and compliance in persons who were attending a cardiac rehabilitation program. Three subscales of the Olivas Health Motivation Scale were administered to a convenience sample of 23 subjects at two points in time: at the beginning and at the completion of the prescribed sessions. A significant relationship was found between Stimulus Outcome Expectations and the duration of exercise at the beginning of the cardiac rehabilitation sessions (r = -.51, p =.02). The relationship between Regimen Efficacy Expectations and the duration of exercise was also found to be significant at the beginning of the sessions (r = -.40, p =.05). There was no significant relationship between health expectations and compliance at the completion of the sessions. One measure of health expectations, Stimulus Outcome Expectations (F = 10.11, p =.01), and two measures of compliance, duration of exercise (F = 406.45, p =.00) and metabolic equivalents (F = 74.14, p =.00), were significantly different between the beginning and the completion of cardiac rehabilitation.

The purpose of the study was to determine the effects of either a programmed instruction booklet or group lecture on knowledge of post myocardial infarction patients. A convenience sample of 30 post myocardial infarction patients enrolled in Cardiac Rehabilitation at a midwestern hospital were asked to participate.Subjects were assigned either to the experimental group or the lecture group. The pretest was administered to both groups. The experimental group received the self instruction booklet and the lecture group received a posttest was immediately completed by the participants. A nonequivalent pretest-posttest repeated measure design was utilized in the study.The results of the study showed a mean improvement in knowledge scores for both the booklet group and lecture group, with the booklet group having the larger gain in knowledge scores. The knowledge gain however, was not significant at the 0.05 level. / School of Nursing

While many short-term physical activity (PA) interventions in cardiac rehabilitation (CR) patients have proven to be successful at increasing PA levels, little is known about the long-term impact these interventions have. The purpose of the current study was to determine if the Increased Physical Activity in Cardiac Patients (IPAC) study utilizing pedometer feedback, motivational messages, and a combination of both were successful at increasing PA levels and improving cardiovascular disease (CVD) risk factors after 12 months. The results of the study indicated that none of the IPAC interventions were successful at increasing PA levels after 12 months compared to the usual care group and all groups reverted back to baseline levels. Additionally, no significant differences were seen across time or between groups in most CVD risk factors. Further research is needed to develop PA interventions in CR patients that foster long-term PA maintenance. / School of Physical Education, Sport, and Exercise Science

Heart disease is a major cause of death in western countries. In order to diagnose and monitor heart disease, 3D echocardiography is an important tool, as it provides a fast, relatively low-cost, portable and harmless way of imaging the moving heart. Segmentation of cardiac walls is an indispensable method of obtaining quantitative measures of heart function. However segmentation of ultrasound images has its challenges: image quality is often relatively low and current segmentation methods are often not fast. It is desirable to make the segmentation technique as fast as possible, making quantitative heart function measures available at the time of recording. In this thesis, we test two state-of-the-art fast segmentation techniques to address this issue; furthermore, we develop a novel technique for finding the best segmentation propagation strategy between points of time in a cardiac image sequence. The first fast method is Graph Cuts (GC), an energy minimisation technique that represents the image as a graph. We test this method on static 3D echocardiography to segment the myocardium, varying the importance of the regulariser function. We look at edge measures, position constraints and tissue characterisation and find that GC is relatively fast and accurate. The second fast method is Random Forests (RFos), a discriminative classifier using binary decision trees, used in machine learning. To our knowledge, we are the first to test this method for myocardial segmentation on 2D and 3D static echocardiography. We investigate the number of trees, image features used, some internal parameters, and compare with intensity thresholding. We conclude that RFos are very fast and more accurate than GC segmentation. The static RFo method is subsequently applied to all time frames. We describe a novel optical flow based propagation technique that improves the static results by propagating the results from well-performing time frames to less-performing frames. We describe a learning algorithm that learns for each frame which propagation strategy is best. Furthermore, we look at the influence of the number of images and of the training set available per tree, and we compare against other methods that use motion information. Finally, we perform the same propagation learning method on the static GC results, concluding that the propagation method improves the static results in this case as well. We compare the dynamic GC results with the dynamic RFo results and find that RFos are more accurate and faster than GC.

Lee Hing Ken. / "November 2001." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (p. 154-159). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.