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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
131

Remote ischemic precondition before hypothermic circulatory arrest in a porcine model:a special reference to oxidative stress

Arvola, O. (Oiva) 31 January 2017 (has links)
Abstract In pathologies of the ascending aorta or in congenital heart defects, circulation may be temporarily halted during surgical intervention. This is achieved by operating under deep hypothermic circulatory arrest or under hypothermia combined with isolated perfusion techniques. For deep hypothermic circulatory arrest (DHCA), the patient is cooled below 18°C using an extracorporeal heart-lung machine, and circulation and breathing are stopped. The advantage of hypothermia is that it decreases oxygen and glucose consumption and provides the surgeons the time required to repair complex heart defects. However, there is still a relatively high risk of neurological complications that can affect the quality of life of patients and their families. One of the methods to mitigate ischaemia-reperfusion injury is remote ischaemic preconditioning. In this work, the neuroprotective mechanisms of remote ischaemic preconditioning (RIPC) were studied in acute and surviving chronic animal models. In study I, we used an acute model, and studied the effects of RIPC in cerebral microcirculation using an intravital microscope and samples analysed by transmission electron microscope. In study II, a chronic model was used to evaluate whether the effects of remote ischaemic preconditioning can be seen in the markers of oxidative stress or in redox-regulating enzymes. Study III was conducted to supplement the findings of study II, considering the markers of oxidative stress. Findings in all studies were consistent with one another. Study I showed the effect of remote ischaemic preconditioning on leukocyte activation and adhesion to cerebrocortical vessels in piglets after prolonged DHCA. Additionally, cellular preservation of endoplasmic reticulum was present in transmission electron microscope analysis of the central nervous system. In studies II and III, the remote ischaemic preconditioning lowered markers of ischaemia-reperfusion-related oxidative stress. In study III the remote ischemic preconditioning lowered oxidative stress already during cardiopulmonary bypass. / Tiivistelmä Hoidettaessa nousevan aortan sairauksia ja synnynnäisiä sydänvikoja verenkierto voidaan tilapäisesti pysäyttää kirurgisten toimenpiteiden ajaksi. Tämä saavutetaan jäähdyttämällä elimistö verenkierron pysäytyksen ajaksi tai jäähdytettynä isoloitujen perfuusiotekniikoiden avulla. Potilas jäähdytetään alle 18 °C lämpötilaan käyttäen kehonulkoista sydän-keuhkokonetta, minkä jälkeen verenkierto ja hengitys voidaan väliaikaisesti pysäyttää. Elimistön viilentäminen vähentää hapen ja glukoosin kulutusta ja antaa kirurgeille aikaa korjata monimutkaisia sydänsairauksia. Verenkierron pysäytyksestä ja palauttamisesta voi ilmaantua keskushermostoon iskemia-reperfuusiovaurioita, mitkä vaikuttavat potilaiden ja heidän läheistensä elämänlaatuun. Esialtistava raajaiskemia on yksi tutkituista menetelmistä lieventää iskemia-reperfuusiovauriota. Tässä työssä esialtistavan raajaiskemian hermostoa suojaavia mekanismeja tutkittiin akuutilla ja kroonisilla koe-eläinmalleilla. Tutkimuksessa I tutkimme esialtistavan raajaiskemian vaikutuksia aivojen mikroverenkiertoon kuvaamalla aivojen pintaverisuonia mikroskoopilla, ja hermosoluihin käyttäen läpäisyelektronimikroskooppia. Tutkimuksessa II kroonisella mallilla tutkittiin voiko esialtistavan raajaiskemian vaikutuksia nähdä oksidatiivisen stressin määrässä tai hapetus-pelkistys reaktioita säätelevissä entsyymeissä. Kolmas tutkimus tehtiin toisen tutkimuksen päätelmien täydentämiseksi mitaten oksidatiivista stressiä. Kaikkien osatöiden löydökset olivat keskenään johdonmukaisia. Ensimmäisessä osatyössä esialtistava raajaiskemia vaikutti leukosyyttiaktivaatioon ja leukosyyttien tarttumiseen aivojen pintaverisuoniin pidennetyn hypotermisen verenkierron seisautuksen jälkeen. Myös hermosolujen sisäisten soluelinten säilyminen näkyi läpäisyelektronimikroskoopilla raajaiskemiaryhmällä. Tutkimuksissa II ja III esialtistava raajaiskemian todettiin alentavan iskemia-reperfuusion aiheuttamaa oksidatiivista stressiä, jonka todettiin tapahtuvan/alkavan jo sydän-keuhkokoneen käytön aikana tutkimuksen III perusteella.
132

Supportive care for patients with heart failure and their partners : A descriptive and interventional study

Ågren, Susanna January 2010 (has links)
Background: Having the support of a partner is essential for both health related quality of life and survival in heart failure patients. However, caring for a patient with heart failure may affect the health related quality of life, well‐being and cause a burden for the partner. The partner is expected to be responsible for the care, which may have consequences for the heart failure patient’s long‐term health and well‐being. Further research to determine health related quality of life, well‐being, caregiver burden and needs of partners is warranted as well as studies evaluating interventions targeting patient‐partner dyads. Aim: The overall aim was to describe how the life situation of patient‐partner dyads was influenced by heart failure and to determine the effects of an intervention of follow‐up with education and psychosocial support for patient‐partner dyads. Design and methods: The thesis is based on three quantitative studies and one qualitative study. The first two studies were descriptive and included 135 dyads (patient‐partner) (I, II) and the randomised intervention study included a total of 155 dyads (IV). The qualitative study had a grounded theory approach. Thirteen partners were interviewed and data analysed using constant comparative method (III). Results: Caregiver burden was perceived as moderate in 30% of the partners and the rest experienced a low caregiver burden. The patients’ physical component score of SF‐36, partners’ mental component score of SF‐36 and perceived control explained 39% of the caregiver burden (I). Patients had lower health related quality of life compared to their partners in all dimensions except in the mental health domain of SF‐36 and lower qualityadjusted life year weights compared to their partners. Mental health scores were lower in partners compared to age and gender‐matched references. All other health related quality of life scores and the quality‐adjusted life year weights were comparable between the partners and the reference group. Patients had more depressive symptoms than their partners. There was no difference in the level of perceived control or knowledge about chronic heart failure between patients and partners (II). During grounded theory analysis confirmation was identified as describing the core category of the partners’ individual needs. The core category theoretically binds together three underlying subcategories: security, rest for mind and body, and inner strength. Confirmation facilitated acceptance and improvement of mental and physical health among partners (III). At the three month follow‐up the dyad‐intervention had improved perceived control in patients, but not in the partners. There were no other significant differences in the control and intervention group with regard to the dyads’ health related quality of life and symptoms of depression. There were also no differences in the patients’ self‐care behaviour and partners’ experiences of caregiver burden (IV). Conclusions and implications: Partners to patients with chronic heart failure are at risk of decreased mental well‐being. One third of the partners experienced a moderate caregiver burden and was therefore at a higher risk of poor mental health and decreased perceived control. During short‐term follow‐up the intervention with education and psychosocial support to dyads (patient‐partner) improved the level of perceived control in the chronic heart failure patient group. By identifying partnersʹ needs for security, rest for mind and body, and inner strength, healthcare professionals can confirm these needs throughout the caring process, from the critical care period and throughout rehabilitation at home. Interventions targeting dyads have been limited in previous research. Partners need to be prepared regarding the disease process, the daily regimen, hopes for the future and responsible care providers. They also need to be confirmed because they are vital to the patients’ recovery. Further, the effects of the intervention study should also include a long‐term follow‐up as well as an evaluation of the health‐economic perspective including direct and indirect costs of care.
133

Risk prediction models in cardiovascular surgery

Grant, Stuart William January 2014 (has links)
Objectives: Cardiovascular disease is the leading cause of mortality and morbidity in the developed world. Surgery can improve prognosis and relieve symptoms. Risk prediction models are increasingly being used to inform clinicians and patients about the risks of surgery, to facilitate clinical decision making and for the risk-adjustment of surgical outcome data. The importance of risk prediction models in cardiovascular surgery has been highlighted by the publication of cardiovascular surgery outcome data and the need for risk-adjustment. The overall objective of this thesis is to advance risk prediction modelling in cardiovascular surgery with a focus on the development of models for elective AAA repair and assessment of models for cardiac surgery. Methods: Three large clinical databases (two elective AAA repair and one cardiac surgery) were utilised. Each database was cleaned prior to analysis. Logistic regression was used to develop both regional and national risk prediction models for mortality following elective AAA repair. A regional model to identify the risk of developing renal failure following elective AAA repair was also developed. The performance of a widely used cardiac surgery risk prediction model (the logistic EuroSCORE) over time was evaluated using a national cardiac database. In addition an updated model version (EuroSCORE II) was validated and both models’ performance in emergency cardiac surgery was evaluated. Results: Regional risk models for mortality following elective AAA repair (VGNW model) and a model to predict post-operative renal failure were developed. Validation of the model for mortality using a national dataset demonstrated good performance compared to other available risk models. To improve generalisability a national model (the BAR score) with better discriminatory ability was developed. In a prospective validation of both models using regional data, the BAR score demonstrated excellent discrimination overall and good discrimination in procedural sub-groups. The EuroSCORE was found to have lost calibration over time due to a fall in observed mortality despite an increase in the predicted mortality of patients undergoing cardiac surgery. The EuroSCORE II demonstrated good performance for contemporary cardiac surgery. Both EuroSCORE models demonstrated inadequate performance for emergency cardiac surgery. Conclusions: Risk prediction models play an important role in cardiovascular surgery. Two accurate risk prediction models for mortality following elective AAA repair have been developed and can be used to risk-adjust surgical outcomes and facilitate clinical decision making. As surgical practice changes over time risk prediction models may lose accuracy which has implications for their application. Cardiac risk models may not be sufficiently accurate for high-risk patient groups such as those undergoing emergency surgery and specific emergency models may be required. Continuing research into new risk factors and model outcomes is needed and risk prediction models may play an increasing role in clinical decision making in the future.
134

Contribution à l'amélioration de la qualité et de la gestion des risques en chirurgie cardiaque. : Conception, réalisation et évaluation de techniques d'enseignement basées sur la simulation sur modèle animal vivant / Risks management and quality of care in cardiac surgery. Implementation and assessment of learning curriculum based on in vivo simulation.

Fouilloux, Virginie 21 November 2014 (has links)
La qualité et la gestion des risques sont devenus, au cours de la dernière décennie, les enjeux principaux au sein des démarches d'amélioration des soins au sein des pratiques médicales et paramédicales.L'enseignement doit constituer un socle solide sur lequel viendront s'échafauder ces différentes démarches. Dans le domaine de la santé, la simulation s'impose comme l'un des outils les plus performants contribuant à l'amélioration des pratiques de soin. Notre travail concerne plus particulièrement le secteur très spécialisé que représente la chirurgie cardiaque. Il propose un modèle d'enseignement basé sur la simulation à partir d'un modèle animal vivant.Après une première étape visant à concevoir l'outil de simulation et sa pertinence, deux modèles de formation ; initiale et continue, sont proposés et évalués.Dans la perspective d'améliorer la qualité et la gestion des risques en France, une comparaison avec les démarches déjà instaurées à l'étranger, et notamment au Canada, est proposée.Enfin, l'École de la CEC vient illustrer ce que pourrait être, en France, un exemple de formation initiale et continue basé sur la simulation et dédié aux professions médicales et paramédicales dans le domaine de la chirurgie cardiaque. / The quality and the risk management became, during the last decade, the main stakes within the initiatives of improvement of medical and paramedical practices.Education and teaching have to constitute the basement on which these various steps can build. In the field of health, the simulation stands out as one of the most successful tools contributing to the improvement of the practices.Our work concerns more particularly the very specialized area represented by cardiac surgery. We propose an educational tool based on the simulation from an in-vivo animal model.After a first stage to design the model and its relevance, two curriculum of training, one concerning basics and the other concerning continuing medical education, are proposed and assessed.To improve the quality and the risk management in France, a comparison with the initiatives already established abroad, in particular in Canada, is depicted.Finally, the School of the CEC comes to illustrate what could be, in France, an example of training curriculum for medical and paramedical professions in the field of the cardiac surgery.
135

Psychologické aspekty u pacientů podstupujících kardiochirurgickou operaci / Psychological aspects in patients undergoing cardiac surgery

Honsová, Karolína January 2019 (has links)
This thesis researches psychological aspects in adult patients undergoing heart surgery. The thesis is divided into theoretical and empirical part. The theoretical part discusses depressive and anxiety symptomatology, quality of life and type D personality, in the context of cardiac surgery. Basic characteristics, possible relations, impacts of occurrence of these aspects and possible related interventions, which seem to be beneficial for cardiac surgery, are presented for each topic. In the empirical part, the symptoms of depression, anxiety and health-related quality of life were examined using a sample of (N = 47) patients undergoing valve surgery. BDI-II, BAI and SF-36 methods were used. The research was conducted in three measurements. The first measurement took place before the surgery, the second before the end of hospitalization and the third took place 30 days after being discharged from the hospital. It was discovered that the depressive symptomatology of our sample differed significantly from the normative sample in the first and second measurements. In the first measurement, the respondents of our sample differed significantly from the norm in the symptomatology of anxiety. In both cases it was an increased symptomatology of depression or anxiety over the norm. In the dimensions of...
136

ERAS for Cardiac Surgery: Development of a Clinical Practice Guideline for Antifibrinolytic Administration in Cardiac Surgery

Foltz, Christopher Thomas 24 April 2022 (has links)
No description available.
137

Predicting Myocardial Injury After Noncardiac Surgery / Prediktion av myokardiell skada efter icke-kardiell kirurgi

Cauli, Giordano January 2023 (has links)
Myocardial injury is the leading cause of death in Europe following non-cardiac surgery. Its causes, diagnosis, and treatment are still under investigation by the scientific community. Some research groups have hypothesized a connection between myocardial injury and hypotension during surgery. This thesis investigated the development of a machine learning binary classifier to make a diagnosis of myocardial injury from a set of patients undergoing non-cardiac surgery. Furthermore, it aimed to clarify the potential of hypotension as a predictor of the pathology. After an evaluation of the requirements that the model had to meet, it was decided to use a decision tree. 4 features were selected combining ANOVA and the domain knowledge of the doctors. The classifier obtained a F1 macro-score of 0.68, showing to have potential in classifying patients as positive or negative. Among the selected features, hypotension obtained the lowest predictive power. Despite the performance of the model, further research is needed to validate the results across different populations and to investigate the use of hypotension as a predictor of myocardial injury. / Myokardiell skada är den främsta dödsorsaken i Europa efter icke-kardiell kirurgi. Dess orsaker, diagnos och behandling är fortfarande under utredning av vetenskapssamfundet. Vissa forskargrupper har hypotiserat om ett samband mellan myokardiell skada och hypotoni under operationen. Denna avhandling undersökte utvecklingen av en binär klassificerare med maskininlärning för att ställa diagnos på myokardiell skada hos en grupp patienter som genomgick icke-kardiell kirurgi. Dessutom syftade den till att klargöra hypotoniens potentiella betydelse som en prediktor för sjukdomen. Efter en utvärdering av modellens krav beslutades det att använda ett beslutsträd. Fyra egenskaper valdes ut genom att kombinera ANOVA och läkarnas domänkunskap. Klassificeraren uppnådde en F1-makropoäng på 0,68 och visade potential att klassificera patienter som positiva eller negativa. Bland de valda egenskaperna hade hypotension den lägsta prediktiva förmågan. Trots modellens prestanda behövs ytterligare forskning för att validera resultaten i olika populationer och undersöka användningen av hypotension som en prediktor för myokardiell skada.
138

Examen du potentiel de l’oxymétrie cérébrale et de l’électroencéphalographie traitée : nouvelle mesure de détection du délirium aux soins intensifs chirurgicaux cardiaques.

Baelen, Sophie 07 1900 (has links)
Des indicateurs physiologiques de l’activité cérébrale pourraient améliorer la détection du délirium. Ce mémoire a pour but de décrire les valeurs d’oxymétrie cérébrale (rSO2) et d’électroencéphalographie traitée (pEEG) pendant les trois premiers jours d’hospitalisation aux SI à la suite d’une chirurgie cardiaque chez le groupe de patients qui présentent un délirium (D+) et chez ceux qui n’en présentent pas (D-), puis de comparer ces valeurs entre les deux groupes. Les mesures concomitantes du Confusion Assessment Method — Intensive Care unit (CAM-ICU), de la rSO2 et de la pEEG sur les ondes alpha, thêta et delta ont été recueillies au premier (J1), deuxième (J2) et troisième (J3) jour à la suite de la chirurgie. Parmi les 125 patients retenus, 10 (8 %) étaient en délirium (CAM-ICU + au moins une fois entre J1 et J3). De J1 à J3, les valeurs de rSO2 moyennes sont similaires pour les deux groupes (D+ : 62,9 à 61,4 %, D- : 62,1 à 58,7 % ; p > 0,05). En comparaison avec le groupe D- en J2, les patients D+ présentent un ratio plus bas d’ondes alpha (2,7 % versus 5,6 % ; p = 0,007) et un ratio d’ondes delta plus élevé (50,5 % versus 45,2 % ; p = 0,009). / Physiological indicators of brain activity could improve the detection of delirium. The purpose of this Master Thesis is to describe the values of cerebral oximetry (rSO2) and processed electroencephalography (pEEG) during the first three days of hospitalization to ICU following cardiac surgery in the group of patients who have delirium (D+) and in those who do not (D-), and then compare these values between the two groups. Concomitant measures of Confusion assessment method — intensive care unit (CAM-ICU), rSO2 and pEEG on alpha, theta and delta waves were collected on the first (D1), second (D2) and third (D3) day following surgery. Of the 125 patients selected, 10 (8%) were in delirium (CAM-ICU + at least once between Day 1 and Day 3). From D1 to D3, the mean rSO2 values are similar for both groups (D+ : 62.9 to 61.4 %, D-: 62.1 to 58.7 %; p > 0.05). Compared with the D- group to D2, the group D+ patients have a lower ratio of alpha waves (2.7 % versus 5.6 % ; p = 0.007) and a higher delta wave ratio (50.5 % versus 45.2 % ; p = 0.009).
139

Long-Term Follow-Up of Mechanical Circulatory Support in Peripartum Cardiomyopathy (PPCM) Refractory to Medical Management: A Multicenter Study

Jawad, Khalil, Koziarz, Alex, Dieterlen, Maja-Theresa, Garbade, Jens, Etz, Christian D., Saeed, Diyar, Langer, Elena, Stepan, Holger, Scholz, Ute, Krause, Michael, Brenner, Paolo, Schulz, Uwe, Borger, Michael A., Eifert, Sandra 02 June 2023 (has links)
Background: Peripartum cardiomyopathy (PPCM) is a rare, life-threatening form of heart disease, frequently associated with gene alterations and, in some cases, presenting with advanced heart failure. Little is known about ventricular assist device (VAD) implantation in severe PPCM cases. We describe long-term follow-up of PPCM patients who were resistant to medical therapy and received mechanical circulatory support or heart transplant. Methods and results: A total of 13 patients were included with mean follow-up of eight years. Mean age of PPCM onset was 33.7 ± 7.7 years. All patients were initially treated with angiotensin-converting enzyme inhibitors and beta-blockers, and four received bromocriptine. Overall, five patients received VADs (three biventricular, two isolated left ventricular) at median 27 days (range: 3 to 150) following childbirth. Two patients developed drive line infection. Due to the short support time, none of those patients had a stroke or VAD thrombosis. In total, five patients underwent heart transplantation, of which four previously had implanted VADs. Median time to transplantation from PPCM onset was 140 days (range: 43 to 776), and time to transplantation from VAD implantation were 7, 40, 132, and 735 days, respectively. All patients survived until most recent follow up, with the exception of one patient who died following unrelated abdominal surgery two years after PPCM recovery. Conclusions: In patients with severe, life-threatening PPCM refractory to medical management, mechanical circulatory support with or without heart transplantation is a safe therapeutic option.
140

A PROCESS MONITORING EVALUATION OF A NURSE-LED REMOTE AUTOMATED MONITORING AND VIRTUAL CARE INTERVENTION

Ouellette, Carley January 2020 (has links)
Clinical trials involving digital health technologies are complex and challenging deployments. The SMArTVIEW trial (n=800), underway, combines remote automated patient monitoring (RAM) in hospital and virtual hospital-to-home nursing support, up to 30-days post-discharge, for patients who have undergone cardiac and major vascular surgery. Cardiac and vascular surgery patients are at risk for postoperative complications, as well as hospital readmission; SMArTVIEW aims to reduce hospital readmissions and emergency department visits. The purpose of this work was to conduct a process monitoring evaluation of the first 100 patients enrolled in order to examine the implementation, mechanisms, context, and specialized nursing role of the SMArTVIEW intervention. Six data sources were used to examine patient recruitment, daily nursing intervention workflows, RAM technology compliance, technical troubleshooting, patient education, and virtual nursing care. A content analysis was used to identify nursing advice, recommendations, and corrective actions for patients requiring intervention recovering at home. Fifty patients were allocated to the SMArTVIEW intervention; of these, 34 engaged in all intervention components, both in-hospital and at home. In-hospital RAM technology generated 194 notifications, drawing nurses to the beside for patient reassessment. Forty-two daily nurse reports and 926 virtual nursing care records were audited to determine technology implementation issues and nursing actions to support patient recovery at home. Process monitoring uncovered strengths and limitations in the initial days of intervention deployment. Strengths included the functionality of RAM technology, facilitating nurse compliance with required workflows, as well as a high degree of patient engagement in the program. SMArTVIEW nurses addressed multiple health concerns for patients, resulting in 1,865 nursing actions over the 30-day intervention course. Patient withdrawals and lack of standardized communication practices were areas requiring improvement. Results were used to refine and standardize intervention workflows in order to scale the intervention for deployment at a second site (United Kingdom). / Thesis / Master of Science (MSc)

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