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Post-operative infections are of high concern and are a great risk to patients who have just had an open-heart surgical procedure. Exposing the human body to elements it's clearly not used to, by opening the chest to perform heart surgery, greatly increases a patient's risk of infection. Surgery is usually the last line of defense used by physicians. This is not only because the invasiveness of the procedure, but because of the heightened risk of infection for the patient. In the treatment of surgical patients, the possibility of infection and protocol for treatment must be taken into account. Patients who undergo open-heart procedures, such as CABG's, Valve Repair/Replacement, Aneurysms, and Aortic Root Repair/Replacement, often have compromised immune systems. A compromised immune system, exposure of the chest cavity during surgery, and length of hospital stay are all contributing factors to hospital acquired infections (HAI). Infections vary depending on the nature of the surgery, the institution, surgical technique, and also varies by patient. Pneumonia, sepsis, bacterial endocarditis, and mediastinitis are all potential concerns in patients who have undergone recent open-heart surgery. The recent societal push for a more holistic approach to medicine and an effort for treatments with fewer side effects have lead to increased research in the realm of probiotics. Probiotics are "good bacteria" that are thought to aid in the intestinal microbial balance. They also have been shown to improve gastrointestinal problems. By integrating the use of probiotics into the treatment of post cardiac surgery patients, we expect to see a decrease in gastrointestinal problems and infections. We also believe that this will improve patients' overall health. This preventative treatment will save the hospital millions of dollars in revenue that is spent on treating infections and will also increase hospital bed turnover.

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Thesis (M.A.)--Boston University

M.Cur. (Intensive General Nursing) / The intensive care unit, as experienced by the patients undergoing coronary artery bypass graft surgery, may have a positive or negative effect on the facilitation of health. This study is an attempt to identify the obstacles as experienced by the patients, in order to help the professional nurse to facilitate health. The objectives of this study: • • to explore and describe the experience of the coronary artery bypass patient in the intensive care unit, to be able to identify obstacles which may impair their health; and to set guidelines for improving the environment. in order to help facilitate health. The phenomenological method of interviewing was used. Interviews were conducted with seven participants. Conclusions were made after analysing the interviews, and theoretical justifications of tho conclusions were found in the literature. The results showed that the lack of guidance was the most important obstacle. and therefore guidelines for the professional nurse in the cardic-thoracic unit were proposed. The goal of these guidelines is to improve the health of the coronary artery bypass patient by improving the intensive care unit environment. Recommendations for practice, nursing education and further research were made.

Aim: To explore parents’ experiences of the transition from hospital to home with their infant, following first stage cardiac surgery for a functionally univentricular heart or systemic shunt dependent cardiac lesion. Background: The process of monitoring a fragile infant at home, in between stage 1 and 2 of cardiac surgery, takes the philosophical perspective of holistic care beyond the borders and boundaries normally expected of parents going home for the first time with their new baby. This neo-transition of becoming a medical parent is superimposed upon the multiple transitions already experienced during the birth and whilst in hospital (new baby, new to parenthood, sick baby, cardiac surgery, ongoing and lifelong care needs). The impact of these transitions, on parents’ wellbeing and the influence of parents’ demographics on their ability to effectively monitor their infant at home, has not previously been studied. Methods: A mixed methods study was conducted in two phases. Phase one was a retrospective survey of 22 families (35% response rate). Phase two prospectively explored parents’ experiences using semi-structured interviews and 3 self-report tools to assess anxiety, depression and confidence; with 13 mothers and 4 fathers of 13 infants. The qualitative data was thematically analysed; descriptive analysis of the quantitative data was undertaken using the Statistical Package for the Social Sciences (IBM SPSS Inc.) version 22 for Windows Results: Most parents felt unprepared for their infant’s discharge home; numerous physical, emotional and social boundaries and borders were evident during the transition from hospital to home, which impacted upon parents’ knowledge and preparedness. Traversing the physical boundary of leaving the hospital for the first time with their infant, was loaded with emotionally traumatic experiences that could not be separated from the specific physical transition of going home. For a while parents were in an uncertain place where they could not visualise what was ahead and how it would feel. This created anxiety and fear, at the same time as excitement to be going home. Liminality as a concept emerged during transition from hospital to home; a crossing point from a comfort zone, safety and security (the ward) into the unknown uncertain place (home). Adjusting to the situation; developing confidence; becoming comfortable with new skills was a threshold concept to mastery of a new normal. Conclusion: Discharge strategies need to be more consistent locally and nationally to ensure that parents are prepared physically, psychologically and socially for discharge home with their infant. Local and community health care professionals need to be better prepared to effectively support these infants and their parents at home.

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A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Doctor of Philosophy Johannesburg, 1998 / Coronary heart disease (CHD) is the most common cause of death in the western world (Roberts, 1992). A high incidence of CHD is also reported for the White and the Asian population of South Africa (Wyndham, 1979). Coronary artery bypass graft (CABG) SL ~..;ry continues to be a proven, effective therapy to relieve symptoms of angina, to improve the patient's quality of life and to prolong life in selected patients (Connolly and Guyton, 1992). This intervention is costly and the operative success of coronary revascularization is limited unless the patient understands and will adhere to the prescribed medical regimen, diet and exercise after surgery (Marshall et al, 1986). The problem is compounded as post-operatively, the symptoms of coronary artery disease are ameliorated and the patient may be unaware of the persistence of the disease process. In additlon, the World Health Organisation's definition of cardiac rehabilitation, puts (olward the concept that the patient must accept responsibility for his or her own recovery (Oldridge, 1986). The role that the patient plays post-operatively must therefore become important in the final outcome. In 1977 Ginzberg wrote: "No improvement in the health care system will be efficacious unless the citizen assumes responsibility k~ his/her own well-being", This statement implies that people must take charge of their own health and not abrogate this responsibility to the experts. This study was designed to determine whether the acceptance of selfresponsibility is all important determinant of the successful outcome of corollary artery bypass graft (CABG) surgery. The final study was preceded by five pilot studies to assist in formulating and identifying the concept of selfresponsibility. Questionnaires were designed to determine aspects of improved quality of life and self-responsibility. For the final study. 75 patients who had undergone CABG surgery, were selected from surgical patients in the private as well as the public sector. In order to assess the acceptance of self-responsibility, the spouses/care-givers of the patients were included in this study. Patients were interviewed 4 to 6 days after the operation, and again six months and 12 months later. Successful outcome was measured in terms of improved quality of life using the criteria suggested by the Coronary Artery Surgery Study (Coronary Artery Surgical Study Principal Investigators, 1983). Tine acceptance of self-responsibility was then investigated as a possible factor influencing the improvement of the quality of life of these patients .. It was found that the acceptance of self-responsibility for the successful outcome of CABG surgery was a significant factor in the group of patients with an improved quality of life (p<0.01). From the results of this study, a profile of South African patients with improved quality of life was identified. They are: Men, married, annual income> R50 000 (US $8 000), who had a normal sex-life prior to the operation. They differ significantly from the group without an improved quality of life in the following aspects: they had spent more hours participatinp in sport at school (p=0.04), had stopped their sporting activities for a shorter period of time prior to the operation (p<0.01) and were taller (p<O.01). They were not depressed 12 months after the operation (p<0.01). Patients who accept self-responsibility for their recovery after CABG surgery have the following characteristics: married (p<0.01), have a level of education> grade 12 (p=O.01), have an annual income: R50 000 (p=O.05). They differ from the group who are not responsible in that they and their spouses/care-givers have more knowledge about the disease and the risk factor modification (p=O.01; p<O.01), and twelve months after the operation the patients are satisfied with the outcome of the operation (p<0.01). A stepwise logistic regression established that the acceptance of selfresponsibility was the strongest predictive fsctor for an improved quality of life after CABG surqe.,: Patients who did not accept responsibility would not have an improved quality of life irrespective of the impact of all other parameters. Patients' satisfaction with the outcome of the operative procedure is an important predictor of the acceptance of self-responsibility. Realistic expectations of the outcome of CABG surgery will improve pati-mts' satisfaction with the outcome ..The knowledge of the spouse is a significant factor in the patients' acceptance of self-responsibility. The spouse of a patient is frequently neglected by health- care workers and yet this person is very important for the patient's successful lifestyle change. Knowledge of the chronic nature of their disease as well as risk factor modification and realistic expectations of the outcome of CABG surgery influences patients' acceptance of self-responsibility. Every effort should be made to assist patients in accepting the responsibility for their own recovery so that the outcome of CABG will be successful. / MT2017

Submitted in fulfilment of the Degree of Doctor of Technology: Clinical Technology, Durban University of Technology, 2009. / INTRODUCTION: The role of modified ultrafiltration (MUF) in removing inflammatory mediators, reducing the need for homologous donor blood and decreasing pulmonary vascular resistance after cardiopulmonary bypass (CPB) has already been established. Different types of MUF systems evaluated illustrated that none of the MUF techniques adhered to the normal venous to arterial blood flow dynamics. OBJECTIVES: This experimental study compared a conventional arteriovenous modified ultrafiltration (AVMUF) system to a custom designed venoarterial modified ultrafiltration (VAMUF) system. This technique of VAMUF was designed to mimic the pro-grade flow pattern of the body and cardiopulmonary bypass circuit as compared to the conventional retrograde AVMUF systems. METHODS: Sixty patients that underwent MUF were divided into two groups, the AVMUF (n = 30) and the VAMUF (n=30) groups. Modified ultrafiltration was performed for a mean time of 12 minutes in both groups. In AVMUF blood was removed from the aorta, haemoconcentrated and infused into the right atrium (RA). In VAMUF blood flow was from the RA through a haemoconcentrator and re-infused into the aorta. RESULTS: There was no significant difference in any of the demographic variables, CPB or crossclamping time. Results showed significant difference in the ventilation times, with the VAMUF requiring a shorter ventilation time than the AVMUF group. Intensive care unit (ICU) stay, Hospital stay and discharge days were all significantly lower in the VAMUF group as well. The VAMUF also showed a lower percentage fluid balance than the AVMUF. The systolic and mean blood pressure was significantly higher after VAMUF with a decrease in heart rate, and central venous pressure (CVP). The VAMUF group showed a significantly greater decrease of Creatinine, serum lactacte and uric acid over time with no significant differences in oximetry. CONCLUSION: Results prove that VAMUF is more effective compared to the conventional AVMUF regarding the haemodynamics and clinical parameters of the patient and is more physiological with regards to blood flow dynamics. The VAMUF is, therefore, a more physiological technique than AVMUF.