Mitte des Jahres 2009 wurden an 30 Tagen am neu installierten Herzkatheterarbeitsplatz der Abteilung für Kardiologie und Angiologie, der Klinik für Innere Medizin Messungen durchgeführt um die Exposition von Untersucher und assistierender Pflegekraft während koronarangiographischer und –interventioneller Prozeduren an einer der modernsten Herzkatheterarbeitsplätze zu erfassen. Dazu wurden an 8 Körperteilen des Untersuchers und Assistenzpersonals (jeweils Auge, Schulter, Handrücken und Unterschenkel beidseits) Thermolumeszenzdosimeter angebracht und diese dann nach einem Untersuchungstag ausgewertet. Bei den Ergebnissen stellte sich heraus, dass die empfohlenen jährlichen Expositionswerte unter den vorherrschenden Bedingungen nicht erreicht werden und die Arbeit an einem modernen Herzkatheterarbeitsplatz als sicher gilt. Jedoch ist das Strahlenfeld als solches sehr inhomogen und weist auch starke Schwankungen je nach Art der Untersuchung, der Erfahrung des Untersuchers und auch der Komplexität des Falles auf. Desweiteren muss beachtet werden, dass die technischen Neuerungen der letzten Jahre erheblich zur Verminderung der Exposition geführt haben und somit an älteren Anlage eine Überschreitung der jährliche empfohlenen Teilkörperdosis als wahrscheinlich gilt.

Thesis advisor: Barabara Hazard / This randomized controlled trial (RCT) examined a discharge nursing intervention (DNI) aimed at promoting self-regulation of care for early discharge interventional cardiology patients. The purpose of this study was to compare medication adherence, patient satisfaction, use of urgent care, and illness perception in patients with cardiovascular disease (CVD) undergoing interventional revascularization procedures who receive usual care and those who receive a DNI. The Common Sense Model (CSM) of illness representation provided the theoretical foundation for this study. The CSM is a cognitive parallel processing model that draws relationships between illness representation, coping methods, and illness outcomes to help explain the process by which people make sense of their illness. Intervention research aimed at life style changes to reduce secondary events after treatment for CVD is needed to guide evidence based care. Treatment for CVD has shifted from surgical repair with prolonged hospitalizations to interventional procedures requiring shorter hospital stays. This trend reduces nursing time to monitor complications and provide education about medication management and lifestyle changes. Patients recover in short stay areas and return home within hours or one to two days of the procedure. Cardiac disease is then managed as a chronic, but often stable condition. With this change in the delivery of care, several trends have emerged that have implications for quality nursing care and patient outcomes: a) the burden of care shifts from the hospital setting to home, b) patients are discharged without extensive education about complications and disease management, c) the occurrence of secondary events and disease progression remain a valid threat, and d) nurses with expert practice are in a unique position to assist patients and families with CVD management. This study addressed the following questions. 1. Do patients receiving the nursing intervention differ significantly from those receiving usual care on medication adherence? 2. Do patients receiving the nursing intervention differ significantly from those receiving usual care on patient satisfaction? 3. Is there a significant difference in the utilization of urgent care between those patients receiving the nursing intervention when compared to those patients receiving usual care? 4. Does a difference exist between the patients receiving the nursing intervention and those patients receiving usual care on illness perception, as measured by seven components of the IPQ-R: time line (acute and chronic), consequence, personal control, treatment (cure) control, illness coherence, timeline (cyclical), and emotional representations? Purposive sampling was used to select a sample of patients admitted for interventional procedures at an academic teaching hospital. One hundred and fifty four patients were and randomized into control and experimental groups. Final analyses included data from 129 patients. Sixty-four participants in the experimental group received the DNI which included: 1) additional written information about taking medications, 2) a medication pocket card, 3) a list of 3 cardiac internet sites,and 4) a phone call, 24 hours post procedure, from an expert cardiac nurse to review discharge instructions. Sixty-five participants in the control group received usual care. Analyses on four outcome measures, medication adherence, use of urgent care, patient satisfaction, and illness perception, revealed one statistically significant result. Participants in the experimental group, receiving the DNI, scored significantly higher than the control group on one measure, the timeline (acute/chronic) component of illness perception (p = .006) indicating a greater appreciation of the chronicity of their disease. Otherwise, there were no significant group differences found. This study provides support for nursing intervention research guided by self-regulation theory that examines the patient's perception of illness. Patients with cardiac disease who received the DNI were statistically more likely to acknowledge that their illness would last a long time. This awareness, may improve adherence to a prescribed regimen of medication and lifestyle modification. Nursing interventions guided by an understanding of patients' belief that their cardiovascular disease is chronic will add to the body of knowledge that informs providers about decisions patients make concerning medication adherence and lifestyle modifications. However, the results underscore the limitations of adding additional discharge care to this population of patients to improve medication adherence, use of urgent care, and patient satisfaction. Future research should include a longitudinal study to examine how patients who perceive their disease to be chronic in nature managed their medications and care decisions at home. / Thesis (PhD) — Boston College, 2009. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

This thesis presents the first work, to our knowledge, to evaluate the potential of Optical Coherence Tomography (OCT) as an intravascular imaging modality to characterize and guide interventions on chronic total occlusions (CTOs) in arteries. An ex vivo imaging study using OCT is presented that characterizes various pathologies associated with peripheral CTOs and illustrates the ability to differentiate between the vessel wall and the occluded lumen. We also found that, while OCT could image approximately 1mm through tissue, it was effective for imaging deeper through clarified microchannels seen within the occluded lumen. While others had reported observing such microchannels within the lumen before, little was known about the global architecture of these channels. This motivated a study of the global morphology of microchannels in occlusions using micro computed tomography (microCT). In this microCT study, we found that microchannels within the occluded lumen of the artery appeared to be continuous over several millimeters. However, these channels also exited the artery frequently, suggesting the need for some form of imaging guidance. As a potential intravascular imaging set-up, a forward-viewing OCT catheter was built. This catheter uses a novel scanning mechanism that combines high voltage and a dissipative polymer to achieve fast compact actuation. Doppler OCT results are presented using this catheter to image flow in the forward direction. Doppler OCT imaging of microchannels in vivo is also shown in a surgically exposed occluded artery in situ.

This thesis presents the first work, to our knowledge, to evaluate the potential of Optical Coherence Tomography (OCT) as an intravascular imaging modality to characterize and guide interventions on chronic total occlusions (CTOs) in arteries. An ex vivo imaging study using OCT is presented that characterizes various pathologies associated with peripheral CTOs and illustrates the ability to differentiate between the vessel wall and the occluded lumen. We also found that, while OCT could image approximately 1mm through tissue, it was effective for imaging deeper through clarified microchannels seen within the occluded lumen. While others had reported observing such microchannels within the lumen before, little was known about the global architecture of these channels. This motivated a study of the global morphology of microchannels in occlusions using micro computed tomography (microCT). In this microCT study, we found that microchannels within the occluded lumen of the artery appeared to be continuous over several millimeters. However, these channels also exited the artery frequently, suggesting the need for some form of imaging guidance. As a potential intravascular imaging set-up, a forward-viewing OCT catheter was built. This catheter uses a novel scanning mechanism that combines high voltage and a dissipative polymer to achieve fast compact actuation. Doppler OCT results are presented using this catheter to image flow in the forward direction. Doppler OCT imaging of microchannels in vivo is also shown in a surgically exposed occluded artery in situ.

Background: Glucagon-like Peptide 1 (GLP-1) is a human incretin hormone that has been demonstrated to protect against non-lethal ischaemia reperfusion injury in the left ventricle in humans. It has been suggested from some animal research that this protection may be mediated through the pathway of ischaemic conditioning, of which the opening of the mKATP channel is a key step. Furthermore, it is uncertain whether the protection applies to the right ventricle. Finally, there is limited human evidence of a protective effect against lethal ischaemia reperfusion injury. Methods: Two studies use non-lethal ischaemia to test whether GLP-1 protection is maintained despite blockade of the mKATP channel with the sulfonylurea, glibenclamide. A demand ischaemia study uses dobutamine stress echo to compare LV function. The other uses transient coronary balloon occlusion to generate supply ischaemia during GLP-1 infusion, assessed by conductance catheter. A further transient balloon occlusion is also used to assess the effect of supply ischaemia on RV function. Finally, the GOLD PCI study assesses whether GLP-1 protects against periprocedural myocardial infarction when administered during elective PCI in a randomised, placebo controlled double blind trial. Results: Glibenclamide did not affect GLP-1 cardioprotection in either supply of demand ischaemia suggesting that GLP-1 protection is not mediated through the mKATP channel. The RV experienced stunning with RCA balloon occlusion but there was little evidence of cumulative ischaemic dysfunction with further occlusions. GOLD PCI is continuing to recruit patients. The nature of the study means results cannot be assessed until recruitment is complete. Conclusions: GLP-1 is an agent with potential for clinical use as a cardioprotective therapy. It’s mechanism of action in the heart remains uncertain.

Mitte des Jahres 2009 wurden an 30 Tagen am neu installierten Herzkatheterarbeitsplatz der Abteilung für Kardiologie und Angiologie, der Klinik für Innere Medizin Messungen durchgeführt um die Exposition von Untersucher und assistierender Pflegekraft während koronarangiographischer und –interventioneller Prozeduren an einer der modernsten Herzkatheterarbeitsplätze zu erfassen. Dazu wurden an 8 Körperteilen des Untersuchers und Assistenzpersonals (jeweils Auge, Schulter, Handrücken und Unterschenkel beidseits) Thermolumeszenzdosimeter angebracht und diese dann nach einem Untersuchungstag ausgewertet. Bei den Ergebnissen stellte sich heraus, dass die empfohlenen jährlichen Expositionswerte unter den vorherrschenden Bedingungen nicht erreicht werden und die Arbeit an einem modernen Herzkatheterarbeitsplatz als sicher gilt. Jedoch ist das Strahlenfeld als solches sehr inhomogen und weist auch starke Schwankungen je nach Art der Untersuchung, der Erfahrung des Untersuchers und auch der Komplexität des Falles auf. Desweiteren muss beachtet werden, dass die technischen Neuerungen der letzten Jahre erheblich zur Verminderung der Exposition geführt haben und somit an älteren Anlage eine Überschreitung der jährliche empfohlenen Teilkörperdosis als wahrscheinlich gilt.

No description available.

Stress cardiomyopathy can cause significant morbidity in the functional life of patients. The most common finding is apical ballooning of the left ventricle on cardiac catheterization. Some cases present with atypical imaging findings. This report presents a case of atypical stress cardiomyopathy with midventricular hypokinesis.

No description available.

Thesis (MScEng (Mechanical and Mechatronic Engineering))--University of Stellenbosch, 2009. / Elderly patients suffering from aortic valvular dysfunction are often denied aortic valve replacement due to the fact that they are classified as too old and fragile to handle the physical stress of open-heart surgery and cardio-pulmonary bypass. There exists a need for an alternative solution which places less physical stress on the body. The development of a percutaneous aortic heart valve (PAHV), which may be implanted through a minimally invasive procedure, will provide a solution to old and fragile patients who otherwise have a very limited life expectancy. The development of such a device entails a costly and time-consuming process which involves a number of phases, including a prototype development phase, an in-vitro testing phase, an animal trial phase and a human trial phase. This thesis focuses on the design and analysis of the stent component for a PAHV, suitable for implantation in sheep (animal trial phase). The process of developing a first prototype, involved an analysis of the stent design requirements. This analysis was followed by a concept generation phase as well as comprehensive finite element (FE) analyses of the most promising concepts. The objective of the FE analyses was to determine the effects of a variation in strut width on the performance characteristics of the concepts. Based on the results of the FE analyses, final geometries were selected for each of the two most promising concepts. Subsequent to the selection of the final geometries, a number of prototypes were manufactured. The prototypes were subjected to an electro-polishing process. An experimental analysis was also conducted on the prototypes to evaluate the accuracy of the (FE) simulations as well as the actual performance of the stent prototypes. The results of the FE analyses and experimental analyses indicated that strut width had a substantial influence on the parameters that were defined to characterise stent performance. The results of the analyses also highlighted the advantages and disadvantages of each concept and aided in identifying the concept that would be most suitable for the required application. Limitations of the study were identified and recommendations were made to assist the continued research and development of the device.