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Precardial ST depression during inferior ST elevation: mechanism and significance黃卓傑, Wong, Cheuk-kit. January 1995 (has links)
published_or_final_version / Medicine / Master / Doctor of Medicine
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Precardial ST depression during inferior ST elevation : mechanism and significance /Wong, Cheuk-kit. January 1995 (has links)
Thesis (M.D.)--University of Hong Kong, 1996. / Includes bibliographical references.
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Precardial ST depression during inferior ST elevation mechanism and significance /Wong, Cheuk-kit. January 1995 (has links)
Thesis (M.D.) -- University of Hong Kong, 1996. / Includes bibliographical references. Also available in print.
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Early risk stratification, treatment and outcome in ST-elevation myocardial infarction /Björklund, Erik, January 2005 (has links)
Diss. (sammanfattning) Uppsala : Univ., 2005. / Härtill 4 uppsatser.
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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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Endogenous t-PA release and pharmacological thrombolysis : experimental animal studies of the coronary circulation /Björkman, Jan-Arne, January 2006 (has links)
Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2006. / Härtil 4 uppsatser.
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O efeito da reperfusão cerebral na deglutição de indivíduos após acidente vascular cerebralRibeiro, Priscila Watson. January 2017 (has links)
Orientador: Maria Aparecida Coelho de Arruda Henry / Resumo: Introdução: A terapia de reperfusão cerebral é uma das modalidades de tratamento do Acidente Vascular Cerebral (AVC) agudo capaz de promover a recuperação dos déficits neurológicos e a redução da incapacidade funcional. A restauração do fluxo sanguíneo pela ação do trombolítico em áreas corticais específicas pode minimizar o grau de comprometimento da disfagia orofaríngea bem como suas complicações. Objetivo: analisar e comparar o desempenho de parâmetros qualitativos e quantitativos específicos da deglutição em indivíduos pós-AVC trombolisados e não trombolisados. Casuística e Método: Estudo coorte prospectivo. Participaram no estudo 32 indivíduos pós-AVC isquêmico, sendo 19 trombolisados (grupo 1) e 13 não trombolisados (grupo 2). Realizado o exame de videofluoroscopia da deglutição e análise da penetração laríngea e aspiração laringotraqueal, Início da Resposta Faríngea (IRF), Tempo de Trânsito Faríngeo (TTF), além do nível de ingestão oral e ocorrência de pneumonia nos primeiros cinco dias após o tratamento de reperfusão cerebral e em 30 dias após o AVC. Resultados: Na comparação entre os grupos em relação à penetração laríngea e aspiração, o grupo de pacientes não trombolisados apresentou maiores índices de penetração laríngea com líquido na avaliação de 30 dias (p=0,007). Quanto às medidas temporais de IRF e TTF, ambos os grupos apresentaram pacientes com alterações nos dois momentos de avaliação, sem diferença estatística entre eles (p=0.646 e p=1,000). A evolução no ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: The cerebral reperfusion therapy is one of the treatments for stroke that promoting recovery of neurological deficits and reduction of functional incapacity. Restoration of blood flow by thrombolytic action in specific cortical areas may minimize the degree of impairment of oropharyngeal dysphagia as well as its complications. The aim of this study was to analyze and compare the performance of specific qualitative and quantitative parameters of swallowing in stroke patients who are both thrombolytic and non-thrombolytic. Method: Prospective cohort study. The study included 32 individuals after ischemic stroke, of which 19 thrombolytic (group 1) and 13 non-thrombolytic (group 2). The videofluoroscopy examination and analysis of laryngeal penetration and aspiration, pharyngeal swallow response (PSR), Pharyngeal Transit Time (PTT), oral intake level and occurrence of pneumonia in the first five days after treatment reperfusion and within 30 days after stroke. Results: In the comparison between the groups in relation to laryngeal penetration and aspiration, the group of non-thrombolytic patients presented higher rates of laryngeal penetration with fluid at the 30-day (p = 0.007). Regarding the temporal measures of PSR and PTT, both groups presented patients with alterations in the two moments of evaluation, without statistical significance between the groups (p = 0.646 and p = 1,000). The evolution in the level of oral intake was higher in the group of patients with t... (Complete abstract click electronic access below) / Doutor
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Popliteal Artery Aneurysm : Epidemiology, Surgical Management and OutcomeRavn, Hans January 2007 (has links)
<p>Even if popliteal artery aneurysm (PAA) is the most common peripheral aneurysm, no single surgeon or institution has enough patients to study this disease with appropriate scientific methods, and no population-based investigation exists. </p><p>PAA epidemiology, treatment, management, and outcome were studied in a population-based study of 571 patients (717 legs) primarily operated on for PAAs and 100 episodes of preoperative thrombolysis in Sweden between 1987 and 2002. Patients were identified in the Swedish Vascular Registry and case-records were reviewed. Information on amputation and survival was obtained for all patients, and 190 patients were re-examined with ultrasound, after mean 7.2 years (range 2-18)</p><p>Median age was 71 years; 5.8% were women. Patients with unilateral PAA had AAA in 28%, increasing to 38% when PAAs were bilateral. Crude survival was 91.4% at one and 70% at five years, significantly lower than among age and sex matched controls. The cumulative incidence for operation of PAA in Sweden was estimated to 8.3/million person year. One-year amputation-rate was 8.8 %, increasing to 11% after follow-up (7.2 years). Independent risk factors for amputation within one year were poor run-off, age, emergency procedure, and prosthetic graft. Run-off was improved by preoperative thrombolysis among 87% of legs, when acute ischemia. After surgical repair with a medial approach the risk of late expansion of the aneurysm was 33%, with a posterior approach 8% , p=0.014. Among 190 re-examined patients, 108 (57%) had at least one additional aneurysm at index-operation, increasing to 131 (68%) at re-examination, the total number of aneurysms increasing by 42% (from 244 to 346).</p><p>Conclusions: Multiple aneurysms are common among patients operated on for PAA. Preoperative thrombolysis improves run-off and decreases the amputation-rate in PAAs with acute ischemia. Vein grafts do better than prosthetic grafts, especially when a long bypass is needed. Posterior approach, when possible, reduces the risk of late expansion. A complete examination of the aorto-iliac and femoro-popliteal arteries is warranted at the time of surgery. All patients should be kept under life-long surveillance in order to detect and treat newly developed aneurysms timely. Normal arterial segments should be re-examined after three years.</p>
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Popliteal Artery Aneurysm : Epidemiology, Surgical Management and OutcomeRavn, Hans January 2007 (has links)
Even if popliteal artery aneurysm (PAA) is the most common peripheral aneurysm, no single surgeon or institution has enough patients to study this disease with appropriate scientific methods, and no population-based investigation exists. PAA epidemiology, treatment, management, and outcome were studied in a population-based study of 571 patients (717 legs) primarily operated on for PAAs and 100 episodes of preoperative thrombolysis in Sweden between 1987 and 2002. Patients were identified in the Swedish Vascular Registry and case-records were reviewed. Information on amputation and survival was obtained for all patients, and 190 patients were re-examined with ultrasound, after mean 7.2 years (range 2-18) Median age was 71 years; 5.8% were women. Patients with unilateral PAA had AAA in 28%, increasing to 38% when PAAs were bilateral. Crude survival was 91.4% at one and 70% at five years, significantly lower than among age and sex matched controls. The cumulative incidence for operation of PAA in Sweden was estimated to 8.3/million person year. One-year amputation-rate was 8.8 %, increasing to 11% after follow-up (7.2 years). Independent risk factors for amputation within one year were poor run-off, age, emergency procedure, and prosthetic graft. Run-off was improved by preoperative thrombolysis among 87% of legs, when acute ischemia. After surgical repair with a medial approach the risk of late expansion of the aneurysm was 33%, with a posterior approach 8% , p=0.014. Among 190 re-examined patients, 108 (57%) had at least one additional aneurysm at index-operation, increasing to 131 (68%) at re-examination, the total number of aneurysms increasing by 42% (from 244 to 346). Conclusions: Multiple aneurysms are common among patients operated on for PAA. Preoperative thrombolysis improves run-off and decreases the amputation-rate in PAAs with acute ischemia. Vein grafts do better than prosthetic grafts, especially when a long bypass is needed. Posterior approach, when possible, reduces the risk of late expansion. A complete examination of the aorto-iliac and femoro-popliteal arteries is warranted at the time of surgery. All patients should be kept under life-long surveillance in order to detect and treat newly developed aneurysms timely. Normal arterial segments should be re-examined after three years.
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Reperfusion therapy in acute ST-elevation myocardial infarction a comparison between primary percutaneous intervention and thrombolysis in a short- and long-term perspective /Aasa, Mikael, January 2010 (has links)
Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010. / Härtill 4 uppsatser.
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