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A study of the memory functioning in the infarct patients: the relationship between test performance, subjectivecomplaints and behavioural indicesFung, Shuk-man, Amy January 1987 (has links)
published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences
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Door-to-needle time in patients with acute myocardial infarction requiring thrombolytic therapyMakgoale, Kgahlego Ramathabathe 04 1900 (has links)
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.
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The trajectory of functional status before and after vascular eventsDhamoon, Mandip Singh January 2016 (has links)
Background: Previous studies that have examined functional status in relation to vascular events have focused on the short term after events and have measured functional status a limited number of times. The trajectories of functional status before and after vascular events are not well characterized, and the factors influencing these trajectories are not well known. Methods: A comprehensive, structured, narrative review was performed on the topic of trajectories of disability and cognition surrounding vascular events. Then using 2 large population-based epidemiologic cohorts, the Northern Manhattan Study (NOMAS) and the Cardiovascular Health Study (CHS), trajectories of functional status were examined. In Analysis A, in NOMAS, the effect of inflammatory biomarkers (interleukin-6 [IL6], tumor necrosis factor receptor-1 [TNFR1], C-reactive protein [CRP], and lipoprotein-associated phospholipase-A2 [LpPLA2]) on the intercept and slope of functional status was determined over a median of 13 years, measured with yearly assessments by the Barthel index. In Analysis B, in NOMAS, a similar modeling strategy was used to examine whether subclinical ischemic disease on brain MRIs, measured by subclinical brain infarct (SBI) and white matter hyperintensity volume (WMHV), was associated with functional trajectories. In Analysis C, in CHS, participants had yearly assessments of disability with a combined activities of daily living (ADL) and instrumental ADL scale. The slope of change in disability was compared before and after vascular events (stroke and myocardial infarction [MI]). Results: In Analysis A, CRP (-0.41 BI points per 1 SD increase, 95% CI -0.82 to 0.002) and LpPLA2 (-0.40, 95% CI -0.75 to -0.04) were associated with baseline BI but not change over time. TNFR1 was associated with baseline BI (-0.93, 95% CI -1.59 to -0.26) and change over time (-0.36 BI points per year, 95% CI -0.69 to -0.03). In Analysis B, functional change was -0.85 BI points per year (95%CI -1.01 to -0.69); among those with SBI there were -0.88 additional points annually (-1.44 to -0.32). In WMHV models, annual functional change was -1.04 points (-1.2 to -0.88), with -0.74 additional points annually per SD WMHV increase (-0.99 to -0.49). In Analysis C, stroke (0.88, 95% CI 0.57-1.20, p<0.0001) was associated with a greater acute increase in disability than MI (0.20, 0.06-0.35, p=0.006). The annual increase in disability before stroke (0.06 points per year, 0.002-0.12, p=0.04) more than tripled after stroke (0.15 additional points per year, 0.004-0.30, p=0.04). The annual increase in disability before MI (0.04 points per year, 0.004-0.08, p=0.03) did not change significantly after MI (0.02 additional points per year, -0.07-0.11, p=0.7). Conclusions: In these large population-based studies with repeated measures of functional status and disability over long-term follow-up, several trajectories were found. In Analysis A, TNFR1 predicted worse overall functional status as well as accelerated decline over time. In Analysis B, both SBI and WMHV were associated with accelerated decline. In Analysis C, there was a steeper decline in function after stroke but not MI. These findings help to elucidate the course and potential etiologies of long-term functional decline related to vascular events, and they suggest directions for future research in this area.
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Social support as a predictor of self-care agency in the post myocardial infarction patientShaw, Cheryl A. January 1992 (has links)
This study examined the relationship between social support and self-care agency in post myocardial infarction (MI) patients. Hypothesis I stated that total social support and it's three subscales are positively related to total self-care agency and it's six subscales. Hypothesis II stated that the three subscales of social support will predict total selfcare agency in post MI patients. A convenience sample of 28 post myocardial infarction patients from a large midwestern metropolitan hospital participated in the study. The Norbeck Social Support Questionnaire (NSSQ) was used to measure the social support variable. The Denyes Self-Care Agency Instrument (DSCAI) was utilized to measure the self-care agency variable. The study supported a positive and significant relationship between social support and self-care agency. The study further supported significant relationships between the subscales of social support and four of the subscales of self-care agency. Affect (a subscale of social support), contributed to 27% of the variance in selfcare agency. The results demonstrated congruent findings with previous studies, reflecting a positive and significant relationship between social support and self-care agency. The study findings have implications for improving nursing practice for myocardial infarction patients and for further nursing research among this population. / School of Nursing
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Correlation study of knowledge and anxiety and nurse coaching in two groups of acute myocardial infarction patients in a phase II rehabilitation programPowell, Mona L. January 1989 (has links)
The purpose of this study was to examine the effects of teaching-coaching interventions on knowledge scores and anxiety scores on a group of individuals In a phase II cardiac rehabilitation program as compared with Individuals not receiving teaching-coaching. Ten individuals received the traditional cardiac rehabilitation program given by the participating hospital. The second group of ten individuals received the traditional cardiac rehabilitation program plus additional teaching-coaching by a registered nurse.Sister Callista Roy's (1984) adaptation model was used as the conceptual framework for this study. Roy's adaptation model was appropriate because the teaching-coaching function of the nurse that was utilized in this study, has been found to help individuals adapt to changes and to decrease anxiety. Roy's model used guidance and direction with the individual's cognator and regulator to promote physiological functioning, improve self-concept, develop role function, and interdependence to bring about adaptation to the myocardial infarction.Hypothesis one and two tested different effects of the teaching-coaching function on two groups of cardiac rehabilitation patients on knowledge scores and anxiety scores by analysis of variance. Hypothesis three determined the relationship between knowledge and anxiety in the two groups by Pearson's product moment correlation.A twenty question multiple choice test focusing on content from the cardiac rehabilitation program, designed by the researcher, determined knowledge gain by the participants. Anxiety was determined by the state section of the State-Trait Anxiety Inventory (Form Y) by Spielberger. The teaching-coaching was accomplished in two thirty minute sessions that focused on content in the cardiac rehabilitation program with each participant by the researcher.The knowledge test and anxiety questionnaire were coded by number to give anonymity. Confidentiality was maintained. The participant was free to discontinue the study at any time without jeopardy.Findings of this study found no significant Increase In knowledge or reduction in anxiety between groups. However, the experimental group that received registered nurse teaching-coaching had a mean score Increase of 3.1 in knowledge scores and mean score reduction of 4.4 In anxiety. Correlation of post knowledge scores and post anxiety scores indicated as knowledge increased anxiety decreased in the participants as related to registered nurse teaching-coaching interventions.Conclusions Indicated that further research is needed to demonstrate the effectiveness of nurse teaching-coaching on knowledge and anxiety. The teaching-coaching function of the nurse warrants strong consideration for further study and use in nursing practice in assisting individuals in recovering from illness and being restored to optimum quality of life. / School of Nursing
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The transfer process patients' responses to selected nursing interventions /Cummings, Maureen T. Maquera, Maria Y. January 1985 (has links)
Thesis (M.S.)--University of Michigan, 1985. / "A research report submitted in partial fulfillment of the requirements for the degree ..."
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The transfer process patients' responses to selected nursing interventions /Cummings, Maureen T. Maquera, Maria Y. January 1985 (has links)
Thesis (M.S.)--University of Michigan, 1985. / "A research report submitted in partial fulfillment of the requirements for the degree ..."
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The relationship between the effect of uncertainty and perceived support role performance in spouses of post-myocardial infarction clientsPayne, Lynelle E. January 1989 (has links)
"The Relationship Between the Effect of Uncertainty and Perceived Support Role Performance in Spouses of PostMyocardial Infarction Clients."Little understanding of the relationship between the illness of a family member and family functioning is provided in recent studies.Studies have indicated that recovery from an illness crisis can be influenced by support from the family. The purpose of this study was to examine spouses of myocardial infarction patients for the relationship between perceived support role performance and the uncertainty regarding the illness of the patient. The population studied consisted of a convenience sample of 36 spouses of patients currently enrolled in Phase II of a cardiac rehabilitation program in a community hospital. Human subjects rights were protected. The hypothesis examined was that "uncertainty has a direct negative relationship to perception of support role performance. Study findings also did not indicate any relationships between the variables of age, gender, support role performance, and uncertainty. The results of the study could be used in planning support groups for spouses of myocardial infarction patients and to provide opportunities for the patient and spouse to form attitudes and acquire skills to master the changes in psychological, social, and physical status. The hospital course of individuals having experienced an acute coronary event is frequently characterized by emotional distress. Nurses can assist family members to identify emotional stresses and intervene to decrease emotional stress. Uncertainty is one factor that can play a role in the perception of illness-related events. / School of Nursing
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Instrument development to assess knowledge of lifestyle changeSteinbinder, Amelia January 1987 (has links)
This study involved designing an instrument to estimate self care knowledge levels of post myocardial infarction patients. The instrument subscales were diet, smoking, exercise, signs and symptoms of cardiac distress, medications, stress and high blood pressure. Twenty-six subjects were tested following hospital discharge and again two weeks later. Test-retest reliability was performed to establish stability of the instrument. The preset criterion level of.70 for the total scale was not met. The medication subscale did meet the.70 criterion level. Reliability estimates were conducted to establish internal consistency of the instrument. The preset criterion level of.70 was not met for the total scale; however, the stress subscale did meet the.70 criterion level on the retest. Concurrent validity was estimated by comparing subscale knowledge scores with self report behavior. Point biserial coefficients did not meet the preset.70 criterion levels. These results suggest that reliability and validity estimates in the post myocardial infarction patient population were not statistically significant. (Abstract shortened with permission of author.)
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Application of cost-effectiveness concepts to cardiac rehabilitation and secondary prevention in Hong KongChau, June, 周宗欣 January 2001 (has links)
published_or_final_version / Medicine / Master / Master of Philosophy
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