The purpose of the present study was to test the theoretical relationship of the concepts of informational support and threat appraisal with a sample of surgical cardiac patients twenty-four hours after discharge from the hospital. These discharged patients were adjusting to the transition of hospital to home environment while still recovering from a life threatening illness. They may need varying informational supports to reduce their threat perception of the magnitude of the illness. A convenience sample of thirty-six surgical cardiac patients was assigned to three groups. The groups received the standard discharge preparation as stated by the hospitals' policy and procedure manual. The experimental group received a supportive and informational telephone call approximately twenty-four hours after discharge. The second group was the placebo group, these participants were given a telephone call at the end of the twenty-four hours to remind them to return the questionnaire. The third group was the control group, received no telephone call and were instructed to complete the questionnaire at the specified time. All groups were instructed at the time of initial contact to complete the questionnaire at approximately the end of the first twenty-four hours after discharge. The placebo group and control group were then pooled for data analysis due to the low return rate of the two groups. The two groups were compared with a t-test. The demographic data compared age and educational level to the perceived level of threat. Reliability of the tool was determined using a Cronbach's Alpha. / School of Nursing

The purpose of this study was to examine the relationship between training heart rate (THR) and the HR occurring at the Aerobic Threshold (AerTHR), and to examine the AerT as an index of training intensity in selected coronary artery disease (CAD), post-myocardial infarction (MI), and post-coronary artery bypass surgery (CABS) patients. Twenty male subjects (age=54.9; wt=73.7 kg; %body fat=25.8) were recruited on the basis of regular participation in a cardiac rehabilitation program (CRP) (3/week at 70 - 85% HRmax) for 6 months; no beta-adrenergic medication; and symptom-free during exercise. Field measurements of THR during the aerobic phase at CRP was carried out by computer-assisted portable telemetry with mean THR computed from each 30 minute value per subject. A maximal treadmill test starting at 2.5 mph at 0% grade with speed increasing 0.5 mph each minute was carried out using a Beckman MMC for 30 second determinations of respiratory gas values. The AerT was determined by visual inspection of the first departure from linearity of Ve and excess CO₂. VO₂max was 35.6 ±5.6 ml/kg/min⁻¹, with HRmax 166.2 ±11.8 bpm. Paired t-tests were performed; AerTHR was 124.8 ±15.3 bpm with THR 133.7 ±13.4 bpm (p < .03). Percent HRmaxAerT was 75.1 ±8.05 and %HRmaxTHR was 80.6 ±8.3 (p < .03). Mean %VO₂maxAerT (54.4 ±6.7) is consistent with other reported data showing .lower values in less trained individuals. Stepwise correlations were performed, and a regression equation was produced to predict AerT grom HRmax, height, and weight with a multiple r = .74 (p < .01). These data suggest that in this population, THR, as calculated by the relative percentage of maximum method, produces training intensities above the AerT expressed as absolute or relative percents of HRmax. This finding may have implications for optimal body fat reductions, patient compliance to the exercise program, and safety in CRP's. / Education, Faculty of / Curriculum and Pedagogy (EDCP), Department of / Graduate

Fifty percent of the diagnosed cases of coronary heart disease in the United States are of unknown etiology. This study proposed that five personality traits— achievement, dominance, aggression, succorance and Critical Parent—differentiate individuals with coronary heart disease manifestations. The ultimate goal of this research was to formulate a predictive profile of at-risk individuals of developing coronary heart disease. Cardiac rehabilitation units' participants from across the United States were recruited as subjects. Randomly selected cardiac rehabilitation units were sent an initial letter inquiring whether their staff would be willing to participate in the study by administering the instruments to their participants. Eight units from each of the 50 states were contacted. A total of fourteen units agreed to participate. One hundred sixty-nine subjects completed the Demographic Data Questionnaire and the Adjective Check List. Five scale scores, representing the five personality differentials, were analyzed. Comparison of the male subject population (n=135) and the male normative population (n=198) revealed no significant differences in terms of the five traits. Comparison of diagnostic subgroups of the subject population also revealed no significant differences. It was concluded that the subject population did not differ significantly from the normative population in terms of the five traits assess by the instrument used. The goal of a predictive profile was not realized due to this lack of findings. / Master of Science / incomplete_metadata

The purpose of this research was to obtain information on the content of education within cardiac rehabilitation programs, methods of administering education, what the barriers are to providing education and which professionals administer education.To reach this goal, a questionnaire was modified from a previous study and a pilot study was undertaken to establish reliability of the questionnaire. The questionnaire was then sent to a sample of 100 directors of cardiac rehabilitation programs belonging to The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). The questionnaire focused on 13 established areas of education within cardiac rehabilitation programs.Once the questionnaires were completed, the information was transferred to a table format based upon the 13 content areas. The following conclusions were drawn from the research and the data gathered: 11 of the 13 content areas are offered at least 84% of the time, the major barriers for the 13 content areas were lack of time and lack of interest on the patient's behalf, the most frequent methods of education for all 13 content areas were individual education, print materials, and group education, and the primary educator overall for all 13 content areas was the nurse followed by the exercise physiologist and dietitian/nutritionist. / Department of Physiology and Health Science

Submitted in fulfillment of the requirements for the Degree of Masters in Technology: Cardiology, Durban University of Technology, 2012. / Cardiomyopathies and their resultant heart failure (HF) remain a major cause of cardiovascular morbidity and mortality (Wood and Picard, 2004). Idiopathic dilated cardiomyopathy (IDCMO) is a primary myocardial disease of unknown cause, characterized by left ventricular (LV) or biventricular dilatation and impaired myocardial contractility. Dilated cardiomyopathy (DCMO), along with rheumatic heart disease and hypertension (HPT), is one of the leading causes of HF in Africa. In fact, in an epidemiology study of 884 patients in Soweto, IDCMO was the second major cause of HF. Thirty five percent of patients in the study, with HF, had IDCMO (Sliwa, Damasceno, Mayosi, 2005). Methodology: Patients referred to the cardiomyopathy (CMO) clinic at Chris Hani Baragwanath hospital, situated in the echocardiographic lab, were recruited, provided they satisfied the exclusion and inclusion criteria and were enrolled after obtaining voluntary informed consent. From May 2009 to September 2010, 70 patients with IDCMO were recruited for this trial. Patients with DCMO were identified by means of echocardiographic criteria which included a left ventricular ejection fraction (LVEF) of less than 45% and an end diastolic dimension (EDD) of greater than of 52 mm (2D in long parasternal axis). Results: In the present study the prevalence of left ventricular (LV) thrombus in patients with IDCMO was 18.6%. When using Univariate logistic regression, the only independent predictors of LV thrombus formation was LVEF and age. However, when multivariate logistic regression analysis was applied to the data, the only predictor with a significant association was age. The reason for this is not clear. It is postulated that perhaps younger patients have differences in the pathophysiology of their disease such as a greater smoldering inflammatory component which may therefore predispose them to thrombus formation. For example the presence of IL-6 may be important in the formation of LV clot in cases of LV dysfunction (Sosin, Bhatia, Davis, Lip, 2003). The association between LVEF and LV thrombus was borderline significant. Conclusion: The prevalence of LV thrombus formation in this cohort of patients with IDCMO was 18.6%. Echocardiographic parameters alone cannot predict which patients are more likely to develop thrombus formation. / National Research Foundation

Thesis submitted to the Faculty of Arts, University of the Witwatersrand, for the degree of Doctor of Philosophy Johannesburg 1995 / The large percentage of deaths attributed to recurrent Coronary Heart Disease (CHD) has generated a search for behavioural and psychological factors which mitigate the consequences of CHD. An aim of the present thesis is to extend this search by identifying factors which predict prognosis fer recovery from CHD. Two key factors seen to influence prognosis are aerobic exercise and Type A behaviour. Extant research into the role of exercise has been hindered by methodological weaknesses. As a consequence, the precise means by which exercise influences CHD patients' psychological and physiological strain remains unclear. Similarly, the Type A literature has been flawed by the inaccurate conceptualisation and measurement of Type A behaviour as a global, and 110t a multidimensional, construct. Research which has examined the multidimensional nature of Type A behaviour has been restricted to low risk samples. Thus, a further aim. of the present research is to examine ; prognostic role of exercise and Type A components within the context of cardiac rehabilitation. In achieving this aim, three studies are conducted. [Abbreviated Abstract. Open document to view full version] / MT2017

Objectives This thesis aimed to explore psychological factors associated with walking behaviour in patients with Peripheral Arterial Disease, within the framework of Leventhal et al’s (1998) Common-sense Model of Self-regulation of Health and Illness. The objective was to identify psychological factors which could be modified to increase walking behaviour in these patients. Method A series of three studies were conducted to achieve these aims. The first study was an exploratory qualitative study, to explore the illness and treatment beliefs and walking behaviour of patients with intermittent claudication. The second study was a cross-sectional postal questionnaire to a cohort of patients with intermittent claudication, which tested the influence of the psychological factors identified in the qualitative study, in a larger sample. The final study was a randomised controlled trial of a brief psychological intervention designed to modify the illness and walking beliefs of patients with intermittent claudication, in order to increase walking behaviour. Results Beliefs about intermittent claudication, and beliefs about walking were both found to be associated with walking behaviour in the qualitative study. The results from the cross-sectional postal questionnaire confirmed this relationship – taken as a set, illness and walking beliefs accurately predicted adherence to minimum walking levels for 93.4% of the sample. The brief psychological intervention successfully modified illness and treatment beliefs and increased walking behaviour in patients newly diagnosed with intermittent claudication. Conclusion This thesis highlights the importance of illness and walking beliefs to the walking behaviour of patients with intermittent claudication. The thesis has added to the body of knowledge about intermittent claudication, and the findings of this thesis have implications for the treatment of patients with intermittent claudication within the health service. Theoretical and clinical implications of this research are discussed.

published_or_final_version / Medicine / Master / Master of Research in Medicine

Coronary artery disease (CAD) is known as the second killer in Hong Kong. The Hong Kong Hospital Authority reported nearly 7000 patients suffered from acute myocardial infarction (AMI) in year 2010 to 2011. Percutaneous transluminal coronary angioplasty (PTCA) is a minimal access surgical treatment for coronary artery disease but studies have shown that patients experienced different levels of anxiety before and during PTCA which led negative impact to the patients. Music can be regarded as a safe, cost-effective therapy to reduce one’s anxiety level. It can be carried out by nurses without any specific technique. However, there was no systemic review for using music therapy to patients undergoing PTCA. Therefore, this dissertation aims to evaluate the best available evidence on using music therapy for patients undergoing PTCA. Four electronic databases, Medline, CINAHL, Embase & PsycINFO, were searched for studies to investigate the efficacy of music therapy in patients undergoing PTCA. There were seven studies were eligible with data extracted and quality assessment performed by the critical appraisal skill programme (CASP) checklist. Four studies were graded as high quality, which consistently demonstrated a statistically significant more reduction in the anxiety level of patients who received music therapy either before and/or during PTCA than those who had no music therapy. Consequently, an evidence-based guideline of using music therapy for patients undergoing PTCA was developed according to the guideline development process of SIGN (2010). The use of music therapy is transferable and feasibly in the local setting with little manpower concern. The total cost estimated for running the innovation for a year was HKD 83,775 which was considered as cost-effective to reduce patients’ anxiety level and avoid associated adverse events. A 14-months programme including communication with the stakeholders, pilot testing, staff training and clinical application of the proposed music therapy was designed. Qualitative and quantitative data on patient, healthcare provider and system outcomes would be accounted throughout the programme. The effectiveness of the guideline would be determined by the reduction of patient’s anxiety level by using the Chinese version of State-Trait Anxiety Inventory (STAI) (Shek, 1993). Moreover, healthcare provider outcome would be evaluated by questionnaire and the expenditure of the proposed music therapy would be monitored closely. / published_or_final_version / Nursing Studies / Master / Master of Nursing

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