Thesis (M.S.)--University of Michigan, 1985.

Thesis (M.Sc.)--York University, 2008. Graduate Programme in Biology. / Typescript. Includes bibliographical references (leaves 77-94). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:MR51626

This study used the research method of phenomenology to elicit the patient's perspective of the illness experience following a myocardial infarction (MI). The purpose of studying this experience was to gain an understanding of what it meant to men and women to have a MI, what the learning needs were following a MI, and how these learning needs were met. It was proposed that patients would view the illness experience differently from health professionals, thus the patients would identify different learning needs. Anderson's (1985) adaptation of Kleinman's health care system framework was used to conceptualize this problem. Three males and two females, ranging in age from 42 to 77 years, participated in the study. Data were collected through 11 in-depth interviews. From analysis of this data significant statements were extracted to provide a description of the phenomenon under study. The findings of this study suggest that health professionals and patients do view the MI experience from different perspectives. The emphasis of the patients on understanding the MI experience from the reality of their world is reflected in their attempts to rationalize the occurrence of the MI and their desires to know more about their own MI, prognosis, and treatment. In order to plan patient education that will assist post-MI patients in their recovery health professionals must assess patients individually for their: (1) beliefs regarding risk factors and causes of MI; (2) desire for Information; (3) preference for method of instruction; and, (4) preference for timing of education. / Applied Science, Faculty of / Nursing, School of / Graduate

This descriptive correlational and longitudinal study was designed to assess the changes in cognitive appraisal of emotions and coping strategies which myocardial infarction (Ml) patients used at two points in time. Additionally, the variables of cognitive appraisal of emotions were investigated for their relationships to coping strategies. A convenience sample of 21 confirmed first MI patients was selected from coronary care units (CCU) of four hospitals in western Canada. Participants completed the Emotion Appraisal Scale, the Revised Ways of Coping checklist as well as an information sheet. Overall, the participants experienced a wide range of the four appraisal types of threat, harm, challenge and benefit. Challenge emotions were the most frequent appraisal type at both interviews. Initially-, benefit emotions were the least frequent appraisal type, while harm emotions were the least frequent at the second period. While results indicated changes, no significant changes were found in the four emotion appraisals of threat, harm, challenge and benefit over time. The complexity of emotions experienced reflects the multifacated nature of the MI situation influencing patients in early phases of recovery. The participants used a variety of coping strategies which are related to emotion-focused and problem-focused coping to manage the demands of their MI. Most of the participants used all eight available types of coping. The strategies of seeking social support, distancing and positive reappraisal were the most predominant types of coping at both interviews. The strategies of self-controlling, planful problem-solving and accepting responsibility were moderately used, while escape-avoidance and confrontive coping were the least used types of coping at both times. The findings suggest that coping with a cardiac event is a complex process. The MI crisis present the patients with multiple tasks which require a combination of coping strategies. At the initial period, a significant relationship was found between threat emotions and planful problem-solving coping. Harm emotions were significantly and positively correlated with accepting responsibility, planful problem-solving and confrontive coping. Similarly, challenge emotions correlated with seeking social support and positive reappraisal coping. Significant relationships were found between benefit emotions and two forms of coping: confrontive and seeking social support coping. At the second period, only two significant correlations were found: benefit emotions significantly correlated with self-controlling and accepting responsibility. The findings suggest that a heart attack is appraised as moderately stressful by first MI patients in early phases of recovery. The MI patients' perception or understanding of the contextual factors affect appraisal of harm, threat, benefit and challenge emotions which in turn influence the choice of coping strategies. / Applied Science, Faculty of / Nursing, School of / Graduate

The potential use of four radioiodinated fatty acids as myocardial imaging agents were evaluated. Preliminary distribution studies revealed that the terminal labeled fatty acids demonstrated higher myocardial uptake. Thus, 10-Iodocapric acid (10-iododecanoic) and 12-Iodolauric acid were subjected to further investigation. Comprehensive tissue distribution studies involving both radioiodinated fatty acids in mice indicated that the highest accumulation of the total injected activity occurred in the muscle and the blood. Other organs investigated included the heart, liver, lung, kidneys, spleen, stomach, intestines, bone and adrenals. The heart exhibited the highest concentration of the radioiodinated fatty acids for the relative accumulation of activity per unit weight. Erom the tissue distribution studies, the optimum scanning time was found to be immediately following injection of the radiopharmaceutical. Toxicity studies were performed in mice after intravenous administration of 10-Bromocapric acid and 12-Bromolauric acid. The LD₅₀ of Sodium Bromolaurate in 10% Human Serum Albumin was found to be 210 mg/kg (194 mg/kg - 228 mg/kg). The stability problem encountered with 10-Bromocapric acid necessitated the use of a different solvent system. The LD₅₀ obtained after intravenous injection was found to be 86.1 mg/kg (83.0 mg/kg - 89.3 mg/kg). However, this observed toxicity may not necessarily reflect the toxicity of the Bromocapric acid solely. Whole body excretion studies were performed in mice and revealed a triexponential excretion curve. For 10-Iodocapric acid, the effective half-lives were .90 hours (36.7%), 3.91 hours (61.6%) and 74.9 hours (14.5%). For 12-Iodolauric acid, the effective half-lives were 1.67 hours (46.6%), 7.68 hours (38.4%), and 71.6 hours (17.8%). For both 10-Iodocapric acid and 12-Iodolauric acid, the first as well as the second component of the excretion curve presumably represented a decrease in the whole body activity due mainly to urinary excretion. The third component appeared to represent activity which was tightly bound and slowly released. The third component presumably represented elimination by fecal excretion. The excretion of the injected activity was primarily in the urine, although some activity was recovered in the feces. For 10-Iodocapric acid, 82.4% of the injected activity had been recovered in the urine within the first 24 hours and 8.88% had been recovered in the feces. For 12-Iodolauric acid, 78.9% of the injected dose was recovered in the urine at 24 hours and 9.4% in the feces. From the urine results, the effective half-life of the radio-iodinated fatty acids in the kidneys was found to be 4.8 hours. Myocardial scans were done on rabbits using ¹³¹I-capric acid, ¹³¹I-lauric acid, NaI-131 (6% Human Serum Albumin), and Thallium-201 at specified time intervals after injection. Iodine-123, a radionuclide possessing more favorable imaging properties, was not readily available due to production problems at the time of scanning. The mean absorbed dose to the whole body, the liver, the kidneys, the muscle, and the heart were computed based on the results from the distribution and excretion studies. The dosimetry calculations were done using Iodine-123 as the radionuclide. For ¹³¹I-capric acid, the radiation doses were calculated as 34.76 mrads/2 mCi for the whole body, 136.3 mrads/2 mCi for the kidneys, 86.6 mrads/2 mCi for the liver, 38.5 mrads/2 mCi for the muscle, and 25.89 mrads/2 mCi for the heart. For ¹³¹I-lauric acid, the radiation doses were 41.73 mrads/2 mCi for the whole body, 199.8 mrads/2 mCi for the kidneys, 185.9 mrads/2 mCi for the liver, 52.07 mrads/2 mCi for the muscle, and 46.39 mrads/2 mCi for the heart. / Pharmaceutical Sciences, Faculty of / Unknown

This exploratory study examined the phenomenon of loss as expressed by the spouses of myocardial infarction patients. The purpose of the study was to describe the thoughts, feelings, actions and observable behaviours of the spouses from the initial impact of illness to six weeks post myocardial infarction and to develop a framework, based on the literature, which related the concept of loss to the experience of spouses of M.I. patients. The study was conducted with a convenience sample of 12 spouses, ten women and two men, whose partners had experienced their first myocardial infarction. Using a semi-structured interview guide with open-ended questions, the investigator interviewed each subject four times over a six week period; from the initial impact of illness to approximately six weeks post myocardial infarction. Each interview covered three content areas: thoughts, feelings and actions. Broad open-ended questions were used to elicit data on the spouses thoughts, feelings and actions. During the interview the investigator observed the verbal (type, quality, characteristics of speech, focus of conversation) and non-verbal (activity, eye contact, body language, appearance) behaviours of the spouses. An empirical inductive approach was used as the methodology for this study. Data coding and analysis were approached using the constant comparative method, an inductive method of discovering grounded theory developed by Glaser and Strauss (1967). The findings revealed that the spouses experienced behaviours in response to loss that were common and formed a pattern through time. Three distinct phases were identified: Phase I The Event and Initial Spousal Response; Phase II Reaction to the Event; Phase III Impact of the Event. The phases were described further in light of the constructs formulated from the literature review: (1) Reactions to Loss; (2) The Elements of Loss; (3) The Meaning of Loss. This study was designed to provide insight into understanding the event of a myocardial infarction within the context of the phenomenon of loss. The findings supported the use of a loss framework for assessing the reactions of spouses who are threatened with the death of their partner. Nurses are in a critical position to assist spouses experiencing loss. Implications and recommendations for nursing education, practice and research were delineated in light of the conclusions of the present study. / Applied Science, Faculty of / Nursing, School of / Graduate

Bakgrund: Hjärt- kärlsjukdom är i dag den främsta dödsorsaken i Sverige för både kvinnor och män. Hjärtinfarkt uppkommer när en åderförkalkning i hjärtats kranskärl brister och det bildas en propp. Kvinnors och mäns symtombild under den akuta fasen skiljer sig mycket åt och det kan även erfarenheterna efter hjärtinfarkten göra.   Syfte: Syftet med denna studie var att beskriva kvinnors erfarenheter efter att ha drabbats av en hjärtinfarkt.   Metod: En litteraturstudie baserad på elva kvalitativa studier. Artikelsökningen genomfördes i Cinahl, PubMed och APA PsycINFO. Därefter analyserades studierna med hjälp av Fribergs analysmodell.   Resultat: Resultatet visar att kvinnor kan uppleva olika erfarenheter efter en hjärtinfarkt. De upplevde fysiska-, psykiska-, sociala- och existentiella förändringar i vardagen och resultatet kunde delas in i tre kategorier och nio subkategorier. Kategorierna var: Påverkan på återhämtningen, Förändringar i det vardagliga livet och Förändrad syn på livet. Konklusion: Litteraturstudien visar att kvinnor upplevde hjärtinfarkten som en dramatisk omställning i livet. Flera olika symtom var vanligt förekommande och kunde hålla i sig i flera år. Kvinnorna lärde sig hantera och acceptera situationen efter en tid men var i behov av stöd från familj, vänner, vård och rehabiliteringsgrupper. / Background: Myocardial infarction is today the leading cause of death in Sweden for both women and men. Myocardial infarction occurs when atherosclerosis in the coronary arteries of the heart ruptures and a blockage forms. The symptoms of women and men during the acute phase are very different and so can the experiences after the myocardial infarction.  Aim: The purpose of this study was to describe women's experiences after suffering a myocardial infarction.  Methods: A litterature study based on eleven qualitative studies. The article search was conducted in Cinahl, PubMed and APA PsycINFO. The studies were then analyzed using Friberg’s analysis model.   Results: The results show that women can have different experiences after a myocardial infarction. They experienced physical, mental, social and existential changes in everyday life and the result could be divided into three categories and nine subcategories. The categories were; Impact on recovery, Changes in everyday life and Changed outlook on life. Conclusion: The literature study shows that women experienced the myocardial infarction as a dramatic change in life. Several different symptoms were common and could persist for years.  The women learned to handle and accept the situation after a while but were in need of support from family, friends, care and rehabilitationgroups.

A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfillment of the degree of Master of Science in Medicine, 2014 / The earliest possible initiation of reperfusion therapy is necessary to reduce morbidity and mortality from acute STEMI. Therefore improving the time to thrombolysis where percutaneous coronary interventional facilities are limited or do not exist is critical. The most effective system would integrate three key components to deliver continuous patient care, including: 1) from time of call for help through to emergency response; 2) transportation to and admission to hospital; 3) assessment and initiation of thrombolytic therapy. The purpose of this prospective study is: to develop a chest pain awareness education programme appropriate for the South African context; to assess safe initiation of thrombolytic therapy by emergency care practitioners for STEMI; and to compare the performance of emergency care practitioner thrombolysis with historical control data.

Thesis (MCur)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: A heart attack is a medical emergency and a life threatening disease. Patients with chest pain and a possible diagnosis of myocardial infarction require a detailed assessment and prompt medical management. The aim of the study was to determine the in-hospital delay in administrating thrombolytic therapy to patients with acute myocardial infarction (AMI) A mixed method with convergent parallel design was applied to the study. The population consisted of N=63 case notes of adult patients diagnosed with acute myocardial infarction and who had received thrombolytic therapy. The other population included (n=8) registered professional nurses working in the coronary care unit (CCU) of a tertiary hospital in the Western Cape. A record review was done using a data extraction form and semi-structured interview guide was used for data collection purposes. Reliability and validity was tested by the use of a nurse expert and a statistician. The nurse expert evaluated the data extraction form to ensure that all variables are included. A pilot study was done to test the data extraction form for errors. Ethical approval was obtained from the Health Research Ethics Committee of Stellenbosch University and permission to conduct the study was obtained from the management where the study was conducted. Informed consent was obtained from the participants. Data analysis was done by the researcher and a qualified statistician. Data was presented in the form of tables, histograms and frequencies. Analysis for the qualitative data was done by the researcher and the following themes were identified: cardiovascular nursing care, roles and responsibilities of nurses, scope of practice, perceptions of nurses on DNT and factors influencing DNT. Themes were presented in a form of a table and thereafter discussed extensively. Results: A total of 63 case notes of patients diagnosed with AMI were identified. The case notes were identified from the register kept in the CCU of the tertiary hospital. The case notes were of patients diagnosed with AMI and received thrombolytic therapy between the period of January 2009 to January 2014. A list of identified case notes was sent to Medical Records department for the retrieval of files. Once the files were retrieved, notes were obtained and used for data collection and analysis purposes (record review). Eleven (11) case notes could not be recovered, ten other case notes had incomplete data, two patients were thrombolysed at remote hospitals and one had a negative value after analysis. A total of 24 patients were excluded from the study. Only 39 patients were eligible for the study. The median door-to-needle time (DNT) of 30 minutes with a range between five to eighty five minutes was achieved. A door-to-needle time of 30 minutes or less was achieved in 23 (59.0%) of the patients; 56.25% of the patients arrived by ambulance and 43.75% used private transport. Of all the patients diagnosed, 24.5% had a pre-hospital ECG; more than 50% (n=30, 76.9%) of the population were smokers and 53.8% of the population had a risk factor of hypertension. The predominant infarct was inferior (61.5%), followed by anterior (38.5%). More than 70% of the patients were assessed by a junior registrar and only (23.1%) by the senior. Furthermore, (n=10, 25.6%) of the population was assessed by the junior registered professional nurse (RPN) and (n=29, 74.4%) by the senior RPN. Population had a median length in hospital of four days. Three patients died due to complications. The researcher read through all the transcriptions to achieve an overview of the interview. The aim was for the researcher to become immersed with the data. From the data, the researcher created codes and themes qualitatively and counted the number of times they occurred. Similar themes were grouped together and subthemes that emerged from the main themes were identified. The main themes identified were: cardiovascular nursing care, roles and responsibilities, scope of practice, perceptions of nurses on door-to-needle time (DNT) and factors influencing DNT. Conclusions: The majority of patients (74.4%) were assessed by a senior registered professional nurse (RPN) on presentation, yet (n=16) of the patients were not thrombolysed within 30 minutes. Patient, doctor, personnel, hospital and ECG factors influenced door-toneedle time in this study. Few nurses working in the CCU showed insight into DNT. The majority of the nurses reported that they have never seen a delay in DNT yet not all patients achieved a DNT of 30 minutes or less. No significant relationship was found between DNT and factors associated with DNT. There was no significant relationship between door-toneedle time and length of hospital stay p=0.40. Recommendations were made to improve patient care and management. / AFRIKAANSE OPSOMMING: ’n Hartaanval is ’n mediese noodgeval en ’n lewensgevaarlike siekte. Pasiënte met borspyn en ’n moontlike diagnose van miokardiale infarksie benodig ’n gedetailleerde assessering en vinnige mediese bestuur. Die doel van die studie was om die in-hospitaal vertraging in pasiënte met akute miokardiale infarksie (AMI) wat trombolitiese terapie benodig, te bepaal. ’n Gemengde metode is gebruik in die studie. Die populasie het bestaan uit N=63 gevalnotas van volwasse pasiënte wat gediagnoseer is met akute miokardiale infarksie en wat trombolitiese terapie ontvang het. Die ander populasie het bestaan uit (n=8) geregistreerde, professionele verpleegkundiges wat in die koronêre sorgeenheid van ’n tersiêre hospital in die Wes-Kaap werk. ’n Data-ontginningsvorm en semi-gestruktureerde onderhoude is gebruik vir data insamelingsdoeleindes. Betroubaarheid en geldigheid is getoets deur ’n verpleegkundige deskundige en statistikus. Die verpleegkundige deskundige het die dataontginningsvorm geëvalueer om te verseker dat alle veranderlikes ingesluit is. ’n Loodsstudie is onderneem om die data-ontginningsvorm vir foute te toets. Etiese toestemming is verkry van die Gesondheidsnavorsing-etiekkomitee van Stellenbosch Universiteit en toestemming om die studie uit te voer is van die bestuuur van die instansie waar die navorsing uitgevoer is, verkry. Ingeligte toestemming is van die deelnemers verkry. Data-analise is gedoen deur die navorser en ’n gekwalifiseerde statistikus. Data is aangebied in die vorm van tabelle, histogramme en frekwensies. Resultate: ’n Totaal van 63 gevalnotas van pasiënte gediagnoseer met AMI is geïdentifiseer. Elf (11) gevalnotas kon nie verkry word nie en tien ander gevalnotas het onvolledige inligting bevat, twee pasiënte is getrombolitiseer by afgeleë hospitale en een het ’n negatiewe waarde na analise gehad. ’n Totaal van 24 pasiënte is uitgesluit uit die studie. Slegs 39 pasiënte was in aanmerking vir die studie. Die median deur-tot-naald (DTN) tyd van 30 minute is bereik wat strek tussen vyf tot vyf-en-tagtig minute. ’n DTN tyd van 30 minute of minder is bereik in 23 (59.0%) van die pasiënte, 56.25% van die pasiënte het per ambulans aangekom en 43.75% het privaatvervoer gebruik. Van al die pasiënte gediagnoseer het 24.5% ’n prehospitaal EKG gehad, meer as 50% (n=30, 76.9%) van die populasie was rokers en 53.8% van die populasie het ’n risikofaktor vir hipertensie gehad. Die oorhersende infark was minderwaardig (61.5%), gevolg deur anterior (38.5%). Meer as 70% van die pasiënte is deur ’n junior registratrateur geassesser en slegs 23.1% deur die senior registrateur. Verder is 25.6% (n=10) van die populasie deur die junior professionele geregistreerde verpleegkundige geassesseer, en 74.4% (n=29) deur die senior geregistreerde verpleegkundige. Die populasie het ’n median lengte van verblyf van vier dae in die hospitaal gehad. Drie pasiënte is dood as gevolg van komplikasies. Konklusie: Die meerderheid van pasiënte (74.4%) is geassesseer deur ’n senior geregistreerde professionele verpleegkundige tydens aanbieding, alhoewel (n=16) pasiënte nie binne die eerste 30 minute getrombolitiseer nie. Pasiënt, dokter, personeel, hospitaal EKG was faktore wat deur-tot-naald tyd in die studie beïnvloed het. Min verpleegkundiges wat in die koronêre versorginseenheid gewerk het, het insig in DTN getoon. Die meerderheid van die verpleegkundiges het gerapporteer dat hulle nog nooit ’n vertraging in DTN gesien hiet nie, tog het nie alle pasiënte DTN in 30 minute of minder behaal nie. Geen beduidende verhouding is tussen deur-tot-naald tyd en lengte van verblyf in die hospital gevind nie (p=40). Aanbevelings is gemaak om pasiënt-behandeling en –bestuur te verbeter.

published_or_final_version / abstract / Medicine / Master / Master of Philosophy