Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.S.)--University of Michigan, 1993.

Congestive heart failure (CHF) is one of the leading causes of hospitalisation, morbidity and mortality in the UK. The incidence and prevalence of CHF is expected to increase due to the aging population and improved survival in heart disease. Exercise has been recognised as a valuable treatment and has proved to be beneficial in CHF. The present study applied the Theory of Planned Behaviour (TPB) and the Commonsense Model of Self-regulation to fitness, daily activity and medication-adherence in elderly patients with CHF. The study was in parallel with a randomised controlled trial of a 3-month exercise programme. A TPB questionnaire was used at baseline and at 3 months. Illness representations were assessed by IPQ-R at baseline. Fitness (measured by 6 minute walk test) and daily activity (measured by an accelerometer) were assessed at baseline, 3 and 6 months. ACEI-adherence (assessed by measuring serum ACE level) was assessed at baseline. The main findings from 81 CHF patients (mean age = 81 years) showed that Subjective norm (SN) was the only predictor of Intention (IN1) at baseline; Attitude, Perceived behavioural control (PBC) were predictors of INT at 3 months; fitness was predicted by PBC at 3 months. The exercise intervention led to significant changes in Attitude and PBe. The finding also indicated that the participants were more likely to attribute their illness to Chance, BiolOgical factors and God. Identity and Illness coherence predicted fitness, and Consequences predicted daily activity. Participants who believed that their illness was chronic or serious were less likely to adhere to ACEI medication. Conclusion: both the TPB and IPQ-R were useful instruments to predict behaviours in elderly patients with CHF. The IPQ-R had a greater predictive power than the TPB in this population. Illness representations may play a role in influencing the formation of intention as background factors.

M.Sc. (Med.)--Faculty of Health Sciences, University of the Witwatersrand, 2011 / In-part through a decrease in cardiac cavity dimensions (reverse remodelling), β-adrenergic receptor blockers have been demonstrated to produce marked benefits to morbidity and mortality in patients with chronic heart failure. However, maximum doses of these agents are often difficult to achieve in patients with chronic heart failure because of the negative inotropic, hypotensive and other side effects. Whether blockade of the excessive adrenergic effects achieves complete reverse remodelling in progressive heart failure is nevertheless uncertain. To test this hypothesis I simulated the adverse effects of chronic adrenergic stimulation on the heart by administering daily doses of the β-adrenergic receptor agonist, isoproterenol (ISO) (2.42 X 10-8 mmol.kg-1) to rats for 6 months and compared left ventricular (LV) dimensions and systolic function to Saline-vehicle treated rats. To imitate the effects of complete adrenergic receptor blockade following the development of adrenergic-induced adverse cardiac changes, I similarly administered ISO for 6 months and then subsequently withdrew the daily ISO administration for a further 4 months (ISO+Recovery) before comparing left ventricular dimensions and function to Saline+Recovery treated rats. In comparison to a Saline vehicle-treated group, after 6 months of ISO administration, LV end diastolic and systolic diameters, and the volume intercept of the left ventricular diastolic pressure-volume relationship (LV V0), were markedly increased and LV endocardial fractional shortening (FSend), LV end systolic chamber (slope of the systolic pressure-volume relationship-Ees) and myocardial (slope of the systolic stress-strain relationship-En) contractility were substantially decreased. The extent of the adverse remodelling produced by chronic ISO administration was exemplified by the 2.5 times increase in LV V0 (ISO=0.40±0.04 vs Saline=0.16±0.01, p<0.001), a change proportionate to that noted in humans with chronic heart failure. iii The proportion of ISO-treated rats with LV chamber diameters, and LV V0 values above the 95% confidence interval for Saline-treated rats was markedly greater than the proportion of Saline-treated rats above their own 95% confidence intervals. Moreover, the proportion of ISO-treated rats with FSend, LV Ees and LV En values below the 95% confidence interval for Saline-treated rats was markedly greater than the proportion of Saline-treated rats below their own 95% confidence intervals. Following a 6 month period of ISO administration and a subsequent period of withdrawal of ISO administration for a further 4 months, LV chamber diameters, LV V0, FSend, LV Ees and LV En were all noted to be similar to age-matched Saline+Recovery control rats. Indeed, the increases in LV V0 observed after 6 months of ISO administration were completely reversed (ISO+Recovery=0.21±0.02 vs Saline=0.23±0.02, p<0.001). The proportion of ISO+Recovery rats with LV chamber diameters, and LV V0 values above the 95% confidence interval for the Saline+Recovery rats was similar to the proportion of Saline+Recovery rats above their own 95% confidence intervals. Moreover, the proportion of ISO+Recovery rats with FSend, LV Ees and LV En values below the 95% confidence interval for Saline+Recovery rats was similar to the proportion of Saline+Recovery rats below their own 95% confidence intervals. Chronic ISO administration and the withdrawal of ISO administration was not associated with changes in myocardial necrosis (pathological score and myocardial collagen concentrations). In conclusion, marked cardiac dilatation and pump dysfunction produced by chronic β-adrenergic receptor activation can be completely reversed by withdrawal of the excessive adrenergic stimulus. These data highlight the importance in chronic heart failure of achieving complete blockade of the pathways activated by excessive β-adrenergic receptor stimulation even in individuals with advanced cardiac dilatation.

This thesis examines the retention of best practices by clinicians after the implementation of an integrated care pathway for patients with congestive heart failure. While the literature suggests there are many reasons why the implementation of best practices is difficult, there is little information on the sustainability of best practices once implemented.<p>Using a qualitative research design guided by Rogers theory of Diffusion of Innovations the researcher interviewed seven clinicians who participated in the implementation of the pathway. A thematic analysis revealed several themes that ran throughout participants responses. <p>While the participants indicated they see value in best practices, they also identified barriers to getting that knowledge into practice and keeping it there. A spectrum of factors, including individual autonomy, time, resources, organizational support and the organization of the system all played a role.<p>In the end, participants revealed that although small pieces of the pathway remain in practice, the pathway itself is no longer used by clinicians to manage patients with congestive heart failure.

This thesis examines the retention of best practices by clinicians after the implementation of an integrated care pathway for patients with congestive heart failure. While the literature suggests there are many reasons why the implementation of best practices is difficult, there is little information on the sustainability of best practices once implemented.<p>Using a qualitative research design guided by Rogers theory of Diffusion of Innovations the researcher interviewed seven clinicians who participated in the implementation of the pathway. A thematic analysis revealed several themes that ran throughout participants responses. <p>While the participants indicated they see value in best practices, they also identified barriers to getting that knowledge into practice and keeping it there. A spectrum of factors, including individual autonomy, time, resources, organizational support and the organization of the system all played a role.<p>In the end, participants revealed that although small pieces of the pathway remain in practice, the pathway itself is no longer used by clinicians to manage patients with congestive heart failure.

Thesis (Ph. D.)--University of Wisconsin-Madison, 2002. / Includes bibliographical references (p. 240-252). Also available on the Internet.

No description available.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Göteborg : Univ. , 2007. / Härtill 5 uppsatser.