The Geriatric Depression Scale (GDS) was originally designed as a measure for screening depression among elderly medical patients. Although this instrument is well validated among a general medical population, it has never been evaluated with specific regard to cardiac patients, the largest single group of medical patients over 40 years of age. A general cardiac sample of 655 patients completed the GDS within 10 weeks of the cardiac event. Exploratory factor analyses were conducted on the main sample, then on several subgroups of participants with regard to diagnostic category, gender, and age. The GDS generally produces factor structures with several symptom domains with a high rate of total variance. The myocardial infarction group endorsed general symptoms of depression whereas the coronary artery bypass graft group reported greater levels of despair regarding their condition. Overall, males primarily reported agitation and hopelessness while females reported symptoms of depressed mood.

The direct effect of spouse presence during graded exercise testing on anxiety and performance has not been previously delineated. Therefore, the purposes of this study were to (a) ascertain if spouse presence during graded exercise testing affects state anxiety or physiological performance variables, and (b) determine differences in psychological status between cardiac patients and healthy adults.

A knowledgeable person can deal with problems in a confident and flexible manner. This statement is certainly applicable in the area of health where an adequate knowledge helps clients to avoid complications. This study was conducted to explore the perceptions of ischemic heart disease patients and their families regarding the content and format of health education they need, before discharge from the hospital. A non-experimental survey study was conducted in the coronary care unit (ccu) of three governmental hospitals in Abu Dhabi, United Arab Emirates (UAE). A convenient sample of one hundred and twelve (112) participants consisting of eighty (80) patients and thirty two (32) relatives, were selected over a three month period. A self-report approach was used to collect data and a questionnaire in the form of five point Likert scale, was developed with appropriate content matching the study purpose. Reliability was tested by test- retest for nine (9) patients not participating in the sample. A panel of experts tested its validity. The confidentiality of the participants was carefully considered. The study has revealed that patients and their families indicate a strong need for health education. Most of the sample prefers health education during the hospital stay by the doctor, although nurses and different health service members were also seen as being important. The respondents perceived the health education function as increasing their confidence in dealing with the disease, while reducing their readmission and anxiety. They preferred a member of the family to attend the session. They wanted comprehensive health education addressing a wide range of topics. Since the study result agreed with other previous research results, it confirmed that people's perceptions about the need for information is similar in the UAE and everywhere else in the world. / Thesis (M.Cur.)-University of Natal, Durban, 2002.

Background: Cardiac Rehabilitation (CR) has been shown to be effective in reducing mortality and morbidity in Coronary Heart Disease (CHD). There is a limited amount of research that evaluates the impact of menu-based CR, in patients with Acute Coronary Syndrome with Low Troponin levels (ACSLT). Aim: This thesis contains a feasibility study and an exploratory study. The feasibility study aimed to examine the feasibility of a Randomised Controlled Trial (RCT) which would test the impact of a menu-based CR programme, on individuals diagnosed with ACSLT, against standard care. This feasibility study included staff views. The exploratory study aimed to explore the impact that ACSLT and CR can have on this client group. Method: The feasibility study was a repeated measures case-control trial of menu-based CR based on the theoretical framework of the Common Sense Model of Self-Regulation (CSM), using a range of health assessments. The areas assessed included misconceptions, symptoms, anxiety, depression and Health Related Quality of Life (HRQoL). In addition, focus groups were held with both ward and specialist CR staff to seek their views on the feasibility of a RCT of menu-based CR for ACSLT. The exploratory study consisted of description and analysis of the data that had been collected from the participants over the two year period as above. In addition it included qualitative data that had been collected during interviews with the participants. Findings: Participants (n=33) were recruited from cardiology wards following an admission with ACSLT. They were assessed at baseline (T1), nine months (T3) and 24 months (T4). Twenty-five participants completed the studies. The feasibility study was successful in its aim of testing the CR intervention and protocols for a further RCT. The intervention was acceptable to the participants and to the specialist staff, although the ward staff did not see the need for a RCT. The measures used, with the exception of the self-reporting measures, were suitable and provided a wide range of data that could be utilised in a RCT. However the changes to diagnostic categories meant that a RCT would no longer be feasible. The exploratory study found that both groups were similar on a range of baseline demographic and clinical factors. There was a tendency to benefit within the exploratory study which favoured the intervention. An additional finding from the exploratory study was the degree of uncertainty experienced by the participants, within the context of a changing political and clinical landscape. Discussion and conclusions: The studies presented in this thesis add to our knowledge by highlighting some of the difficulties in designing a RCT of menu-based CR in a specific subgroup of CHD and by presenting outcome data for a small group of participants that have not previously been studied within the literature. This data suggests that there was a tendency to benefit for the intervention that requires further study. Implications for practice: Patients with ACSLT are now being included in CR programmes due to the changes within the diagnostic criteria. Clinicians have little understanding of the impact of CR on this group of patients, or what type of interventions would work best. Large RCT’s will however be problematic and this thesis has highlighted that further work is required to explore how CR can best improve the well-being of individuals with ACSLT.

This qualitative study sought to explore the Hong Kong Chinese patient's perceptions of an Intensive Care experience and their views on the introduction of feng shui principles focussing on sleep orientations, dietary management and exercise regimes. The study explored the background of feng shui as an authentic traditional Chinese belief. It also explores if incorporating these feng shui principles into the health care setting would provide a positive effect for open-heart patients in an Intensive Care Unit at the Hong Kong Adventist Hospital in Hong Kong. The major inference drawn from this study is that Chinese patients seek culturally related experiences from the health care setting. The Chinese informants showed strong belief patterns in traditional practices of feng shui, however, practiced these within the confines of their homes as these experiences were denied to them in the hospital setting. / Health Studies / M.A. (Nursing Science)

This qualitative study sought to explore the Hong Kong Chinese patient's perceptions of an Intensive Care experience and their views on the introduction of feng shui principles focussing on sleep orientations, dietary management and exercise regimes. The study explored the background of feng shui as an authentic traditional Chinese belief. It also explores if incorporating these feng shui principles into the health care setting would provide a positive effect for open-heart patients in an Intensive Care Unit at the Hong Kong Adventist Hospital in Hong Kong. The major inference drawn from this study is that Chinese patients seek culturally related experiences from the health care setting. The Chinese informants showed strong belief patterns in traditional practices of feng shui, however, practiced these within the confines of their homes as these experiences were denied to them in the hospital setting. / Health Studies / M.A. (Nursing Science)

Background: Beta blockers are recommended by the American College of Cardiology/American Heart Association Guidelines for high and intermediate-risk cardiac patients undergoing non-cardiac surgery. Beta blockers are a class of drugs that moderate the effects of increased catecholamine levels on the heart by selectively blocking beta receptors in the heart and blood vessels, resulting in a lower heart rate and blood pressure. Beta blocker use perioperatively has been shown to reduce the risk of ischemia and infarction. Purpose: The purpose of this project is to address beta blocker use in a group of anesthesia providers who routinely attend to high-risk and intermediate-risk cardiac patients undergoing non-cardiac surgery in a medium-sized private hospital in suburban South Florida. There are barriers to the implementation of the published guidelines for beta blocker administration, including lack of awareness of the best current practice and a lack of a formal beta blocker protocol at the institutional level. Methods: A simple and inexpensive beta blocker protocol was implemented and evaluated by various means. Beta blocker administration practices were examined and documented prior to and after protocol implementation. Beta blocker usage was examined prior to and after protocol implementation Findings/Implications: It was hypothesized that increased anesthesia provider awareness would lead to increased administration of perioperative beta blockers to high-risk and intermediate-risk cardiac patients undergoing non-cardiac procedures. Although there was a knowledge increase related to the new beta blocker protocol, no change in practice was observed.

A quantitative research design for a descriptive and contextual study to determine the critical care nurses knowledge and data preferences regarding the central venous and pulmonary artery catheters management and decision making after coronary arte.y bypass graft operations and the utmzation period of the pulmonary artery catheter after coronary artery bypass graft operations. The data was collected through a questionnaire completed by critical care nurses and retrospective analysis of patient records through a structured checklist. Data analysis indicated the following: critical care nurses have a knowledge deficit in the management of the central venous and pulmonary artery catheters and felt more competent and confident in the central venous measurements. The utilization period of the pulmonary artery catheter was 48% compared to the 100% of the central venous catheter. / Advanced Nursing Science / M.A. (Advanced Nursing Science)

A quantitative research design for a descriptive and contextual study to determine the critical care nurses knowledge and data preferences regarding the central venous and pulmonary artery catheters management and decision making after coronary arte.y bypass graft operations and the utmzation period of the pulmonary artery catheter after coronary artery bypass graft operations. The data was collected through a questionnaire completed by critical care nurses and retrospective analysis of patient records through a structured checklist. Data analysis indicated the following: critical care nurses have a knowledge deficit in the management of the central venous and pulmonary artery catheters and felt more competent and confident in the central venous measurements. The utilization period of the pulmonary artery catheter was 48% compared to the 100% of the central venous catheter. / Advanced Nursing Science / M.A. (Advanced Nursing Science)

As doenças cardiovasculares acompanham o homem desde os tempos antigos. Mas foi apenas na sociedade moderna que elas se transformaram na principal causa de mortalidade no mundo. A manutenção da saúde é eixo central para se garantir o direito à vida, definido como direito fundamental pela nossa Constituição. Assim, desenvolver uma ferramenta específica para o atendimento aos pacientes de maior risco para estas doenças contribui para que este direito fundamental seja garantido na prática. Além disso, as doenças cardiovasculares são responsáveis por impactos negativos na economia, tanto pelos custos de atendimento como pelo potencial em incapacitar uma parcela da população que está em idade produtiva. Dadas estas características vem sendo desenvolvidas estratégias de saúde pública para sua prevenção e atendimento precoce. Este estudo se propôs a criar e avaliar a eficiência de um escore para estratificação de pacientes em espera para atendimento ambulatorial eletivo de cardiologia, com vistas a identificar aqueles de maior risco. Foi aplicado num ambulatório de cardiologia do Hospital de Clinicas da UFPR, com resultados iniciais promissores. O resultado da aplicação mostrou excelente sensibilidade/especificidade em identificar os pacientes de alto risco para eventos cardiovasculares, que deveriam ter seu atendimento ambulatorial priorizado, reduzindo assim a possibilidade de eventos cardiovasculares futuros. Entretanto, para sua completa validação deve ser testado em um universo maior de pacientes. / Cardiovascular diseases follow the man since ancient times. But, it was only in modern society that they have become the main cause of mortality worldwide. Maintaining health is the central axis to guarantee the right to life, defined as fundamental right by Brazilian Constitution. So, to develop a specific tool for the patient care at higher risk related to these diseases contributes to guarantee this fundamental right in practice. In addition, cardiovascular diseases are responsible for negative impacts on the economy, by both service costs and the potential to disable a portion of the working age population. Due to these characteristics, public health strategies have been developed for its prevention and early treatment. This study aimed to create and evaluate the efficiency of a score for stratification of patients waiting for elective outpatient cardiology, for identifying those at greatest risk situation. The SPECC was applied in an outpatient cardiology at Hospital de Clinicas, UFPR, with promising initial results. Result of its application showed excellent sensitivity/specificity in identifying patients at high risk for cardiovascular events, for whom outpatient care should be prioritized, thus, reducing the possibility for future cardiovascular events. However, for a complete validation, it should be tested in a larger patient population.