This study examined the impact of a designed nursing intervention protocol on myocardial infarction patients' outcomes at a university hospital in Egypt. Forty adult myocardial infarction patients were included. The study found that after exposure to the nursing intervention protocol, patients had significantly higher total mean knowledge scores and total mean practice scores. It also found that patients had medium to high levels of compliance to lifelong instructions. The results support the hypotheses that the nursing intervention protocol improved patients' knowledge, practices, and compliance. The study concluded that a nursing intervention protocol can have a positive impact on myocardial infarction patient outcomes.
Knowledge and attitudes towards complementary and alternative medicine among ...home
Majority of the medical students were familiar with the CAM methods widely used in Turkey, while
most of them had positive attitudes towards CAM as well as willingness to receive training on the subject, and they
were likely to recommend CAM methods to their patients in their future professional lives. With its gradual scientific
development and increasing popularity, there appears a need for a coordinated policy in integrating CAM into the
medical curriculum, by taking expectations of and feedback from medical students into consideration in setting
educational standards
The effect of clonidine on peri operative neuromuscular blockade and recoveryAhmad Ozair
Background: Alpha-2-agonists are as used adjunct for anaesthesia. We conducted this study with the aim to determine whether the addition of clonidine, an α-2-agonist, decreases the time to recovery from neuromuscular blockade caused by non-depolarising muscle relaxant. Secondary objectives were to know whether clonidine as an adjuvant improves hemodynamic stability, decreases stress hyperglycaemia, pain and time to discharge from Post-Anaesthesia Care Unit (PACU). Methods: This placebo-controlled clinical trial, enrolled 64 patients into clonidine (n = 32) or placebo (saline) group (n = 32). Study drug was given 1.5 mcg/kg IV bolus at the time of induction followed by infusion (1.5 mcg/kg/hour) intra-operatively. Extubation was started when train-of-four (TOF) count was ≥ 2. Primary outcome measure was time to achieve TOF ratio of ≥ 70% and ≥ 90%, assessed at 5, 15, 30- and 60-min intervals following extubation. Results: 2 patients in each group were excluded due to intra-operative requirement of additional supportive medications, hence in each group 30 were analysed. Significant difference was observed between clonidine and placebo groups in terms of time to achieve TOF ratio ≥ 70% and ≥ 90%, stress hyperglycemia, hemodynamic and pain profile, no statistical difference in the Ramsey sedation score and modified Aldrete score between groups. Patients given clonidine required repeat doses of non-depolarising muscle relaxant at longer intervals, with decrease in total amount administered. Clonidine group had a median time to achieve TOF ratio ≥ 70% at 15 min compared to 60 min in placebo group. Conclusion: Clonidine hastens the recovery from neuromuscular block with reduced stress hyperglycaemia and post-operative pain, along with unaffected Ramsey sedation score and modified Aldrete score.
Integrative Telerehabilitation Strategy after Acute Coronary SyndromeIgnacio Basagoiti
Poster presentation in e-Cardiology & e-Health Congress Berna 2014 by Ernesto Dalli , Sergio Guillén , Ignacio Basagoiti , Jaime H. Horta , Lourdes Peñalver , José L. Marqués , Clara Bonanad from Department of Cardiology, Hospital Arnau de Vilanova, TSB SA , Departament of Cardiology, Hospital Politécnico Universitario La Fe and Department of Cardiology, Hospital Clínico Universitario, Valencia, Spain.
Knowledge and attitudes towards complementary and alternative medicine among ...home
Majority of the medical students were familiar with the CAM methods widely used in Turkey, while
most of them had positive attitudes towards CAM as well as willingness to receive training on the subject, and they
were likely to recommend CAM methods to their patients in their future professional lives. With its gradual scientific
development and increasing popularity, there appears a need for a coordinated policy in integrating CAM into the
medical curriculum, by taking expectations of and feedback from medical students into consideration in setting
educational standards
The effect of clonidine on peri operative neuromuscular blockade and recoveryAhmad Ozair
Background: Alpha-2-agonists are as used adjunct for anaesthesia. We conducted this study with the aim to determine whether the addition of clonidine, an α-2-agonist, decreases the time to recovery from neuromuscular blockade caused by non-depolarising muscle relaxant. Secondary objectives were to know whether clonidine as an adjuvant improves hemodynamic stability, decreases stress hyperglycaemia, pain and time to discharge from Post-Anaesthesia Care Unit (PACU). Methods: This placebo-controlled clinical trial, enrolled 64 patients into clonidine (n = 32) or placebo (saline) group (n = 32). Study drug was given 1.5 mcg/kg IV bolus at the time of induction followed by infusion (1.5 mcg/kg/hour) intra-operatively. Extubation was started when train-of-four (TOF) count was ≥ 2. Primary outcome measure was time to achieve TOF ratio of ≥ 70% and ≥ 90%, assessed at 5, 15, 30- and 60-min intervals following extubation. Results: 2 patients in each group were excluded due to intra-operative requirement of additional supportive medications, hence in each group 30 were analysed. Significant difference was observed between clonidine and placebo groups in terms of time to achieve TOF ratio ≥ 70% and ≥ 90%, stress hyperglycemia, hemodynamic and pain profile, no statistical difference in the Ramsey sedation score and modified Aldrete score between groups. Patients given clonidine required repeat doses of non-depolarising muscle relaxant at longer intervals, with decrease in total amount administered. Clonidine group had a median time to achieve TOF ratio ≥ 70% at 15 min compared to 60 min in placebo group. Conclusion: Clonidine hastens the recovery from neuromuscular block with reduced stress hyperglycaemia and post-operative pain, along with unaffected Ramsey sedation score and modified Aldrete score.
Integrative Telerehabilitation Strategy after Acute Coronary SyndromeIgnacio Basagoiti
Poster presentation in e-Cardiology & e-Health Congress Berna 2014 by Ernesto Dalli , Sergio Guillén , Ignacio Basagoiti , Jaime H. Horta , Lourdes Peñalver , José L. Marqués , Clara Bonanad from Department of Cardiology, Hospital Arnau de Vilanova, TSB SA , Departament of Cardiology, Hospital Politécnico Universitario La Fe and Department of Cardiology, Hospital Clínico Universitario, Valencia, Spain.
Evaluation of the Physical Activity Level among Undergraduate Students of Fac...ijtsrd
Objectives This current study was carried out to evaluate the level of physical activity PA among undergraduate students of faculty of Allied Health Sciences, University of Peradeniya. Materials and methods This was a cross sectional study which was conducted at Faculty of Allied Health Sciences, University of Peradeniya, Sri Lanka. Data was collected through a self administered questionnaire International Physical Activity Questionnaire – Short Form IPAQ SF and total of 231 students responded. Prior to the data collection, informed written consent was taken from the students. Main outcome measures MET value Metabolic Equitant Results The mean total MET of the population indicated that of ‘moderate physical activity level’. Comparing four study years 4th year to 1st year , total MET level was gradually declining from 1st year to 4th year though there were no statistically significant relationship found. PA level was moderate in all the degree programs but the values were different. In relation to sex, males were predominant in all the MET categories. According to the BMI category, normal weighted students were presented with higher values for MET categories compared with others. Conclusion All the students of Faculty of Allied Health Sciences, University of Peradeniya were moderately physically active with higher percentages of walking MET minutes week in all the variables. PA score is gradually declined from first year to final year. RAD students were more physically active among all five degree programs. Male students and normal weighted students had higher PA scores respectively for sex category and BMI category. Senarath MKID | Thalwaththe STRD | Tennakoon SUB "Evaluation of the Physical Activity Level among Undergraduate Students of Faculty of Allied Health Sciences, University of Peradeniya" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-2 , February 2021, URL: https://www.ijtsrd.com/papers/ijtsrd38609.pdf Paper Url: https://www.ijtsrd.com/medicine/other/38609/evaluation-of-the-physical-activity-level-among-undergraduate-students-of-faculty-of-allied-health-sciences-university-of-peradeniya/senarath-mkid
G112 Ito & Shiromaru (2009). Patients’ coping strategies before and after ab...Takehiko Ito
G112 Ito & Shiromaru (2009). Patients’ coping strategies before and after abdominal surgery: A questionnaire survey. The 1st International Nursing Research Conference of World Academy of Nursing Science, Kobe: Program & Abstracts, 235.
Evaluation of the Physical Activity Level among Undergraduate Students of Fac...ijtsrd
Objectives This current study was carried out to evaluate the level of physical activity PA among undergraduate students of faculty of Allied Health Sciences, University of Peradeniya. Materials and methods This was a cross sectional study which was conducted at Faculty of Allied Health Sciences, University of Peradeniya, Sri Lanka. Data was collected through a self administered questionnaire International Physical Activity Questionnaire – Short Form IPAQ SF and total of 231 students responded. Prior to the data collection, informed written consent was taken from the students. Main outcome measures MET value Metabolic Equitant Results The mean total MET of the population indicated that of ‘moderate physical activity level’. Comparing four study years 4th year to 1st year , total MET level was gradually declining from 1st year to 4th year though there were no statistically significant relationship found. PA level was moderate in all the degree programs but the values were different. In relation to sex, males were predominant in all the MET categories. According to the BMI category, normal weighted students were presented with higher values for MET categories compared with others. Conclusion All the students of Faculty of Allied Health Sciences, University of Peradeniya were moderately physically active with higher percentages of walking MET minutes week in all the variables. PA score is gradually declined from first year to final year. RAD students were more physically active among all five degree programs. Male students and normal weighted students had higher PA scores respectively for sex category and BMI category. Senarath MKID | Thalwaththe STRD | Tennakoon SUB "Evaluation of the Physical Activity Level among Undergraduate Students of Faculty of Allied Health Sciences, University of Peradeniya" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-2 , February 2021, URL: https://www.ijtsrd.com/papers/ijtsrd38609.pdf Paper Url: https://www.ijtsrd.com/medicine/other/38609/evaluation-of-the-physical-activity-level-among-undergraduate-students-of-faculty-of-allied-health-sciences-university-of-peradeniya/senarath-mkid
G112 Ito & Shiromaru (2009). Patients’ coping strategies before and after ab...Takehiko Ito
G112 Ito & Shiromaru (2009). Patients’ coping strategies before and after abdominal surgery: A questionnaire survey. The 1st International Nursing Research Conference of World Academy of Nursing Science, Kobe: Program & Abstracts, 235.
Determine the Patients' Satisfaction Concerning In-hospital Information Progr...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care.
Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice
Reducing Stroke Readmissions in Acute Care Setting.docxdanas19
Reducing Stroke Readmissions in Acute Care Setting
Contents
Introduction: 2
Objective of the study: 3
Readmission Factors: 3
Statins: 3
Long term care: 4
Demographics: 4
Personal Reflections: 4
Events: 4
Empirical Evidence: 6
Interventions for discharged patients: 6
TRACS: 7
COMPASS: 7
MISTT: 8
Clinical requirement: 8
Timeline: 8
Collaboration with the preceptor: 8
Proposed evaluative criteria: 9
Evaluative criteria discussed: 9
Conclusion: 9
Bibliography 10
Introduction:
Stroke refers to a cardiovascular disease which has been one of the leading reasons for deaths and long term disability. A stroke is an abrupt onset of a neurological deficit led by a vascular rupture or blockage that reduces the blood flow to brain. Subsequently, causing death to the tissue in the brain region if interruption of the blood flow persists. The indications of stroke vary, but may include the loss of function to one side of the body, the inability to speak or talk, and reduced vision or severe headache (Poston, 2018).
Issue: Discovery Research
Over time, the financial penalties on readmissions to the hospital have been taking place, which is promoting hospitals to take measures to reduce the instance of readmissions. A variety of interventions are taking place on different levels to ensure that pre and post discharge care is in place to avoid readmissions. The efficacy of interventions is dependent on the variety of components. Single component interventions are least effective and tend to have no effect on readmissions to the hospitals. Patients that are discharged to post-acute care accommodations are subjected to multi-component interventions and readmissions have dropped drastically. These interventions work through communication, advanced planning of care, and training to tackle simple medical issues that might cause readmissions. The availability of risk stratification methods have made it easier for the hospitals to give more care and attention to the patients that are more likely to get readmitted. Home based services are provided to ensure proper medical care for the patients.
This capstone project attempts to discuss the factors causing the readmissions of stroke patients to the hospitals. The past 20 years have proven to be important in acute and inpatient stroke care however, quality of post-acute care varies specially for the patients that are discharged to home. (Condon, Lycan, & Duncan, 2016). Different reasons for stroke readmissions are to be examined in this capstone project. Expected Outcomes: Discovery Research
This project aims to take into account the reasons of stroke and readmissions after being treated for stroke. Stroke is the second primary reason of readmissions in the hospital. Major readmissions comprise of elderly people. 20-70% people who survive stroke are readmitted in the first year of their treatment (Bravata, Ho, Meehan, & Brass, 2006). Poor health conditions and high treatment costs both account for the l.
Background: Cardiac catheterization is considered as the gold standard practice for the recognition and diagnosis coronary heart disease. The hazard physically and emotionally occurs from this procedure can disturb the patient’s perception of their health. Nursing care is vital in survival and avoids the patients from post cardiac catheterization problems. So the competence of nurses about knowledge and practice regarding patient care after cardiac catheterization is very crucial. Aims: the aim of this study to investigate the effect of creating learning guideline for nurses caring for patients safety undergoing cardiac catheterization. Methods: A quasi experimental research design was conducted. The study was conducted at the Cardiac Catheterization intensive care, cardiac care and emergency units at general Port Said hospital in Port Said city – Egypt. Subjects: A purposive sample of 51 nurses was working in those departments. Tools: two tools were utilized. Tool I: consisted of the following: Part 1: Socio-demographic data of the nurses. Part II: nurses’ knowledge about cardiac catheterization. Tool II: Nursing care after cardiac catheterization to providing patient safety. Results: The study revealed that the majority of nurses have a highly satisfactory level of knowledge and performance regarding patient safety on cardiac catheterization post implementation the learning guideline than pre learning guideline. It was reflected positive correlation between nurses qualification, experience and knowledge regarding patient’s safety at post learning guideline with significant difference regarding experience. While, there was a strong positive correlation between the performance of studied nurses and their qualification regarding the post learning guideline implementation with significant. Finally, positive correlation between performance and knowledge regarding patient safety at post learning guideline implementation. Conclusion: it can be concluded that learning guideline considerably improved the nurses’ level of knowledge and performance regarding Caring For Patients Safety Undergoing Cardiac Catheterization. Overall knowledge score between pre learning guideline and post learning guideline was found to be significant. While, total performance score between pre learning guideline and post learning guideline was found to be not significant. Therefore, the learning guidelines are recommended for educating these nurses to promote knowledge and performance regarding patient safety to decrease hazards following cardiac catheterization.
Perceived benefits and barriers to exercise for recently treated patients wit...Enrique Moreno Gonzalez
Understanding the physical activity experiences of patients with multiple myeloma (MM) is essential to inform the development of evidence-based interventions and to quantify the benefits of physical activity. The aim of this study was to gain an in-depth understanding of the physical activity experiences and perceived benefits and barriers to physical activity for patients with MM.
Effectiveness of Nurse Led Heart Failure Management Program on Quality of Lif...ijtsrd
Background Heart failure HF is characterized by poor quality of life QOL with high hospitalization rates, and poor prognosis. Younger age groups are more affected in developing countries like India. HF can be very disabling, and QOL of patients can be severely affected Objectives 1. To assess the Quality of Life of Heart Failure patients in Experimental and Control Group. 2. To Compare the effectiveness of Nurse Led Heart Failure Management Program on Quality of life of heart failure patients in Experimental and Control Group. Method The study was conducted for 3 months from 1 Dec to 1 March 2019, in cardiology OPD, at KGMU, U.P, based on simple random sampling the groups were divided into control group and experimental group in which the control group received no intervention and Interventions of Nurse led Heart failure management program was given in experimental group with a Log book which they have to fill once a week for 3 months. Post test questionnaire for Quality of life and log book data will be collected from both the groups after 3 months. Results The result showed significant difference between Quality of life P 0.002 as measured by KCCQ, mean Quality of life was found to be significantly higher among the subjects of Experimental group 60.50±12.10 than control group 46.73±16.23 at post intervention. Conclusion Simple systemic educational intervention that was targeted towards patient to provide a tailored educational intervention through an holistic Perspective, focused on preserving or enhancing health and Self management goal achievement has improve quality of life of heart failure patients those who received NLP i.e, Experimental group, Their Quality Scores were High as Compared to Control group. Conclusion The study concluded that, structured information brochure is an effective way to improve the knowledge and reduce the anxiety among the patient planned for angioplasty. The study recommended that structured information brochure about the post procedural care about the angioplasty should be implemented to improve the knowledge and reduce the anxiety among the patient for providing a better care. Richi Lal | Rashmi P. John | Sharad Chandra "Effectiveness of Nurse-Led Heart Failure Management Program on Quality of Life of Heart Failure Patients in Cardiology OPD, at KGMU, U.P" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-1 , December 2021, URL: https://www.ijtsrd.com/papers/ijtsrd48046.pdf Paper URL: https://www.ijtsrd.com/medicine/cardiology/48046/effectiveness-of-nurseled-heart-failure-management-program-on-quality-of-life-of-heart-failure-patients-in-cardiology-opd-at-kgmu-up/richi-lal
The issue of medical aliteracy has drawn both scholars and medical practitioners’ attention in the recent years. The negative cost of medical aliteracy has continued to constitute major threats to health related issue which has resulted in high mortality rate, high medical expenditure and medical underperformance among others. On this premise the study examined the influence of medical aliteracy among senior medical personnel. The study employed descriptive research design and Chi-Square to test the research hypotheses. A total number of 50 questionnaires were designed to collect information from the sampled population through a random sampling. From the result of the analysis it was revealed that factors such as ineffective supervision of medical personnel, low patient literacy level, lack of personnel-patients engagement could lead to medical aliteracy among senior medical personnel. Senior medical personnel have the knowledge of medical aliteracy and its implications on for medical personnel and the public. Medical aliteracy has an implication on health sector performance which includes increase in mortality rate, increase health expenditure, widening of the gap between patients – medical personnel communication among others. Perception of medical aliteracy has significant influence on medical personnel performance. The study concluded that, medical aliteracy is prevalent among medical personnel and patients and is associated with many poor medical outcomes in the health sector. It was however recommended that medical literacy training, schemes and programmes should be designed according to the needs of the different medical personnel and should therefore be included in medical professional training programs.
โรคเรื้อรังเกี่ยวกับระบบทางเดินหายใจ นับว่าเป็นปัญหาสาธารณสุขที่กระทบต่อคุณภาพชีวิตประชาชนมากเป็นอันดับต้นๆ การพัฒนาระบบการดูแลที่เรียกว่า chronic care model นับว่าจะช่วยทั้ง health and well being คนไข้ ครอบครัว และช่วยทางด้าน equity efficiency ระบบบริการสาธารณสุขด้วย
Presentation of our curricular integration, Interprofessional approaches and Student Leader Training strategies in the second year of our 3 year SBIRT Training Grant.
Learning outcome 1The chronicity of COPD allows for self manage.docxaryan532920
Learning outcome 1
The chronicity of COPD allows for self management by sufferers. (Spencer & Barcomb 2014). The self management goal is reduced hospital admissions and improved life quality (Bedra et al 2013). Sufferers should have access to a wide range of skills available from the multidisciplinary team. Those include exacerbation limitation, respiratory failure, chronic productive cough and anxiety and depression.
Symptom Recognition.
Patients discharged from hospital are susceptible to readmission (Bedra et al 2013). Understanding the condition and knowing when they are having an exacerbation is imperative for self management, and what to do in the given circumstances, and when and what medication to take, or realise they need hospital treatment.
Treatment.
The main form of treatments comes from inhaled therapies and explained below would be when they would be administered and their understandings are a major factor in self management.
For breathlessness and exercise limitations: A short acting Beta2 agonist (as required) or short acting muscarinic antagonist (as required).
For exacerbations or persistent breathlessness: A long acting beta2 agonist, long acting muscarinic antagonist, to – long acting beta2 agonist + inhaled corticosteroid (Combination Inhaler) OR a long acting muscarinic antagonist (must discontinue short acting antagonist once this is commenced).
(Remember if using Corticosteroids, this has no evidence of long terms benefits).
If experiencing persistent exacerbations or breathlessness. Long acting Muscarinic antagonist + long acting beta2 agonist and inhaled corticosteroid (combined inhaler).
Niesters et al, (2012) describe how oxygen therapy can also be used, but awareness of inappropriate oxygen therapy with COPD patients is imperative as this can cause respiratory depression.
Self Monitoring.
The British Thoracic Society (BTS) have identified five high impact actions that can improve outcomes for people being discharged after an acute exacerbation of COPD. The form is a quick way of identifying patients need for those interventions, ensuring their needs are met. The aim is for lessened hospital readmission rates with self monitoring patients. The five actions are;
Review of medication and demonstration of inhalers they will be using.
Provide a written Self Management plan and Emergency drug pack.
Asses and offer referral for smoking sensation.
Assess for suitability for pulmonary rehab.
Arrange a follow up call within 72 hours of discharge.
Educational Interventions.
Reardon et al, (2005) explain pulmonary rehabilitation as programs which work with patients to help manage their condition, muscle strength, ability to cope with their disease, help with social requirements as people can become quite isolated.
Test includes incremental shuttle walk a 10 metre course, consecutive runs, each time getting faster, measured how far they got, will give idea of what they can endure on the exercise programme th ...
Similar to Impact of a designed nursing intervention protocol on myocardial infarction patient's outcome at a selected university hospital in egypt (20)
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Light House Retreats: Plant Medicine Retreat Europe
Impact of a designed nursing intervention protocol on myocardial infarction patient's outcome at a selected university hospital in egypt
1. Journal of Biology, Agriculture and Healthcare
ISSN 2224-3208 (Paper) ISSN 2225-093X (Online)
Vol.3, No.17, 2013
www.iiste.org
Impact of a Designed Nursing Intervention protocol on
Myocardial Infarction Patient's Outcome at a selected University
Hospital in Egypt
1.
2.
3.
4.
Abdelhameed MahrosAbdelhameed1*, Warda Youssef Mohamed2,
Yousria Abd El-salam Seloma3, Hanan El-sayed Zaghla4,
Clinical Instructor of Critical Care and Emergency Nursing, Faculty of Nursing,
Prof. of Critical care and Emergency Nursing, Faculty of Nursing,
Lecturer of Critical Care and Emergency Nursing, Faculty of Nursing,
Lecturer of Critical Care medicine Faculty of Medicine,
* E-mail of the corresponding author: abdelhameedmahros@yahoo.com
Abstract
Background: Myocardial infarction is a life threatening disease that influences the physical, psychological and
social dimensions of the individual. Improper lifestyle is one of the causes of this disease. The designing and
implementing of nursing intervention protocol for MI patients could be one of the important and
fundamental steps in improving MI patients outcomes. Aim: The aim of this study was to examine the impact of
a designed nursing intervention protocol on myocardial infarction patient’s outcomes as indicated by higher post
total mean knowledge scores, higher post total mean practices scores and high level of compliance to lifelong
instruction. Research hypotheses: H1. Patients who will be exposed to a designed nursing intervention protocol
will have a higher post total mean knowledge scores; H2. Patients who will be exposed to a designed nursing
intervention protocol will have a higher post total mean practices scores; H3. Patients who will be exposed to a
designed nursing intervention protocol will have a high level of compliance to lifelong instruction. Design: A
quasi-experimental research design was utilized in this study Sample: A convenience sample of 40 adult male
and female MI patients. Setting: The cardiac care units at a selected Cairo University Hospital were recruited to
fulfill the aim of this study. Tools: Four tools were formulated& tested to collect data pertinent to the study;
Socio-demographic and medical data sheet, Pre/Post knowledge questionnaire sheet, an Observational checklist
and Compliance assessment sheet. Structured interview, reviewing medical records and direct observation were
utilized for data collection. Results: The study results revealed that the post total mean knowledge scores of the
studied subjects is increased significantly with value of t= 20.6 at p=0.000, higher post total practice scores
among the studied subjects with t& p values (t=5.6 at p= 0.000 ) also, studied subjects had mild to high
compliance level regarding the lifelong instructions. Conclusion: It can be concluded that, enrichment of
patients' knowledge and practices in relation to their condition and utilization of the effective nursing
intervention protocol as an approach of care could have a positive impact upon improvement of patients'
outcome. Recommendations: The study recommended Conduction of further studies in order to assess the
effectiveness of the designed protocol on patients' outcome regarding different cardiac disorders with replication
of this study on a larger probability sample from different geographical locations at the Arab Republic of Egypt,
in addition to establishment of cardiac rehabilitation center in the different heath care organizations.
Keywards: Nursing intervention protocol, Myocardial Infarction, Outcomes, Cardiac care units.
1.
Introduction
One of the goals of nursing care is health promotion and prevention of disease. Cardiac rehabilitation achieves
these goals as it a comprehensive program that prepares the patient to full, vital and productive life in the
termination imposed on him by the cardiac disease. It is a process for restoring and maintaining a patient at his
optimal physiological, psychological, and social status. Patient moves from complete dependence to independence
in his activities of daily living (ADL) (Nair, 2009).
The pattern of coronary care has changed, as having treatment philosophies, early hospital discharge is a major
force. Supervised programs of exercise, education and lifestyle changes have improved outcome for client who have
coronary artery disease, myocardial infarction (MI), and other severe cardiovascular conditions (Hoeman, 2002).
Gulanick & Mayers (2011) added, The American Heart Association and American College of cardiology have
developed treatment guidelines for patients with unstable angina and Non ST segment elevation Myocardial
infarction, as well as for ST segment elevation myocardial infarction. Each guidelines addresses initial and ongoing
drug therapy, indication for fibrinolytic and Percutaneous coronary interventions, and discharge consideration. For
patient with MI, the therapeutic goals are to establish reperfusion, to reduce infarct size, to prevent and treat
complications, and to provide emotional support and education. Recovery from unstable angina is shorter than with
myocardial infarction because only ischemic, not infracted, tissue occurs. More than 85% of patients experiencing
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myocardial infarction return to full activity level.
Ackley, Ladwig, Swan &Tucher (2009) reported that, Cardiac disease self-management are personal actions
to manage heart disease and prevent disease progression which are; report symptoms of worsening disease;
performs treatment regimen as prescribed; limits sodium intake; follows recommended diet; participates in
smoking cessation program; participates in recommended exercise program and uses warming signs to seek
health care.
Trials have established that several types of intervention can reduce the risk factors for cardiovascular
disease; improve psychosocial well-being, and patient knowledge; and reduce morbidity and mortality (Hanestad,
Hanssen & Nordrehaug , 2004).
Nurses should provide the patient with an exercise instruction such as instructing the patient to record his
heart rate before and after each phase of exercise and whenever he feels anything unusual during and after each
exercise. Patient may increase speed of walking day by day, and increase the length of walking distance. At the
end of 6-8 weeks patient should be able to engage in brisk walking for 5km/hr. patient may be advised to avoid
static exercise (lifting, carrying, pushing heavy objects)( Nair 2009).
In Egypt, cardiac rehabilitation, usually, is not a part of the routine patient care after acute myocardial
infarction, so The designing and implementing of nursing intervention protocol for MI patients could be one of
the important and fundamental steps in improving MI patients outcomes.
2.
Significance of the study
From clinical observation in the cardiac care and critical care units, it was observed that the number of
patients with ACS has increased over the last years and these patients require intensive collaborative care to save
their lives and they are at risk for several consequences. These consequences in turn may have negative impact on
the patient's physical and psychological condition, and will prolong patient's hospital stay, and increase hospital
costs, That is why there is an interest to conduct such type of research which might safeguard this category of
patients against these serious consequences, In addition, scattered researches where done in this area especially on
the national level.
Furthermore, this research could provide health professionals with an in depth understanding related to this
category of patients which could be reflected positively on the quality of patients' life, The study as well could
support the important role of the nurse in the patients' care through assessing the patient's and providing the
required care and teaching regarding the myocardial infarction, Also it is hoped that findings of this study might
help in improving quality of patient care and establish evidence based data that can promote nursing practice and
research.
3.
Aim of the study
The aim of the study is to assess the impact of nursing intervention protocol on myocardial infarction
patient's outcomes at the cardiac care units- Cairo University hospitals.
4.
Research hypotheses
To fulfill the aim of this study, the following research hypotheses were formulated:
H1. Patients who will be exposed to the nursing intervention protocol will have a higher post total mean
knowledge scores.
H2. Patients who will be exposed to the nursing intervention protocol will have a higher post total mean practices
scores.
H3. Patients who will be exposed to the nursing intervention protocol plan will have a high level of compliance to
medication regimen, diet, exercises, and follows up appointments.
5.
Subjects and Methods:
5.1 Research Design
A quasi-experimental research design was utilized in this study
5.2 Setting
This study was carried out at the cardiac care units affiliated to Cairo University Hospitals, in Cairo
governorate. It is one of the largest educational university hospitals in Egypt in this field. It receives the
cardiac patients all over the day. It receives more than 150 MI patients per year.
5.3 Subjects
A convenient sample of 40 adult male and female patients admitted to cardiac care units at Cairo
university hospitals with acute myocardial infarction for the first time and willing to participate in the
study.
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5.4 Tools
Four tools were developed to collect data pertinent to the study. These tools are:
1-Sociodemographic and medical data sheet (Appendix A):it is a sheet covering two main sections: the first
section is related to sociodemographic data which includes age, gender, occupation, marital status, level of
education, socioeconomic level, nutritional habits, smoking habits etc. and The second section covers medical
data such as date of admission and discharge, diagnosis, vital signs, past medical history& co-morbidities such as
diabetes, hypertension), routine medications, family history, and body mass index
2- Pre/Post knowledge questionnaire sheet (Appendix B): This sheet was formulated to assess patients'
knowledge about risk factors, manifestations, treatment, complications of acute myocardial infarction, warning
signs of recurrent attacks, activities, and life style modifications….etc.
3- Observational checklist (Appendix C): This sheet was developed to assess patient's practices regarding
patients' ability to practice peripheral pulse counting, relaxation technique; deep breathing technique and filling a
diet record.
4- Compliance assessment sheet (Appendix D):This sheet was designed to evaluate subjects' adherence to the
prescribed regimen. It includes six main areas including a) adherence to the life-long post discharge instructions;
b) adherence to prescribed follow up system; c) adherence to prescribed medications regimen; d) adherence to
prescribed diet regimen; e) adherence to prescribed exercise regimen and f) adherence to stress management
techniques. It is a rating scale which is composed of 4 points (always, sometimes, rarely and never).
Ethical consideration
An official permission to conduct the study was obtained from the ethical committee of research and Vice
Dean for Higher Education and Research- Faculty of Nursing and directors of Critical Care Units. Verbal
consents were obtained from head nurses of these units. In addition, patients' agreements to be included in the
study were obtained formally after explanation of the nature and purpose of the study. Each patient was free to
either participate or not in this study and have the right to withdraw from the study at any time without any
rational; also, patients were informed that data will not be included in any further researches without another
new consent if they do not mind. Confidentiality and anonymity of each subject were assured through coding of
all data.
5.6 Techniques for data collections
Structured interview, reviewing medical /nursing records ,direct patients observation and follow up by
phone calls were utilized to fill out the study tools.
5.7 Procedure
The current study was carried out on two phases, designation and implementation phases which are:
5.7.1
Designing phase:
It was concerned with the construction and preparation of the different data collection tools and
instructional booklet in addition to obtaining managerial arrangement to carry out the study.
5.7.2
Implementation phase:
The researchers visited the cardiac care units on daily bases once they find the patient who met the
criteria of selection; socio-demographic and medical data sheet (tool 1) was fulfilled. As well the knowledge
assessment sheet (tool 2) and observational checklist sheet (tool 3) were filled out for the whole group as a
control group. The whole group was exposed to the routine hospital care. Then the whole group was subjected to
the designed nursing intervention protocol on a daily base till discharge as a study group. Then all subjects were
supplied with the predetermined instructional booklet. The compliance assessment sheet (tool 4) was filled out
for all subjects during the first month after discharge. Mainly follow up was done through the open channel of
communication with the investigator through the telephone call to answer their questions, reinforce information,
correct misunderstanding and monitor the patient's adherence to the given instructions.
5.8 Statistical data analysis
Data obtained from the study tools were categorized, tabulated, analyzed and data entry was performed
using the SPSS software (statistical package for social sciences version20.0). Descriptive statistics were applied
(e.g. mean, standard deviation, frequency and percentage). Tests of significance were performed to test the study
hypotheses (i.e. paired and unpaired t- test, chi square test and ANOVA test). Pearson's correlation coefficient
was applied between quantitative variables. A significant level value was considered when p<0.05.The smaller
the P- value obtained, the more significant is the result. The P- value is being the probability of error of the
conclusion.
6.
Results
Findings of the current study are presented in three main sections; section (1) related to sociodemographic data, medical data (table1 and figures1,2,3,4,5,6,7&8), section (2) is concerned with testing the
research hypothesis (figure 9,10&11) and section (3) is concerned with the additional findings(table2&3)
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Section 1:
Figure (1) shows that, 52.5 % of study sample's age ranged from>50 to65 years, and 37.5% of them
were aged between 35to50 years. Figure (2) shows that, more than three fourths of the studied subjects (78 %)
were males. Figure (3) shows that, 85% of studied subjects came from urban areas and figure (4) shows that
(40%) of the studied subjects were overweight and 30% were moderate obese. Figures (5)& (6) shows that,
(72.5%) of the studied subjects were smokers and (37.9%) of them were smoking 10 to 20 cigarettes per day. In
addition that, figure (7) shows that more than half (55% ) of the studied subjects were diagnosed as STEMI
while (44% )of them diagnosed NSTEM and figure(8) shows that (37.5%) of them have not any co-morbidity
diseases.
Table (1) revealed that more than one third (37.5%) of the studied subjects were able to read and write
and (80%) of them were having a work. In addition that, (47.5%) of the studied subjects were used to eat foundry
and fatty diet and (72.5%) dose not drink coffee.(97.5%) of the studied subjects does not practice any sports.
Finally only (15%) of the studied subjects has positive family history for the cardiac disease.
Section (2):
Figure (9) indicating higher total knowledge scores among the studied subjects, ranked as satisfactory to
good levels. However, all of the studied subjects (100%) remained with an unsatisfactory knowledge level before
receiving the designed protocol which is supporting the first hypothesis which stated "Patients who will be
exposed to a designed nursing intervention protocol will have a higher post total mean knowledge scores".
Figure (10) shows that (100%) were having unsatisfactory level of practice before receiving the designed
protocol, this percentage decreased to be (45%)after receiving the designed protocol, the other (55%) of the
studied subjects were having satisfactory (25%) and good (30%)level of practice and this is supporting the
second hypothesis which stated "Patients who will be exposed to a designed nursing intervention protocol will
have a higher post total mean practices scores". finally, it appears from figure(11)that, (50%) of the studied
subjects has medium total compliance level to the lifelong instructions, while (47.5%) of them has low level of
total compliance, and shows also the different subtotal compliance scores ranking from low to high level of
compliance which could partially support the third hypothesis which stated "Patients who will be exposed to a
designed nursing intervention protocol will have a high level of compliance to lifelong instruction".
Section (3)
Table (2) revealed that, there is a significant positive statistical correlations between total knowledge
scores and total practice scores, total practice scores and total compliance scores and total compliance scores and
total knowledge scores (r = 0.569, p =0.000), (r =0.509, p =0.001) and (r=0.338 ,p=0.033) respectively.
Table (3) Demonstrates that, there is a highly significant statistical difference was found between
educational level and total mean knowledge, practice and compliance scores of the studied subjects.
7. Discussion
The present study delineated that more than three fourths of the cases are male and more than half of the
study sample's age ranged between >50-65 years old. This agreed with Bare, Cheever, Hinkle & Smeltzer (2010)
who mentioned that risk factors for the development of coronary artery diseases “CAD” increases with age and
male gender. In accordance with these results, Bos-Scheap, Hautvast, Heestermans, Wit &Umans (2011)
reported in a published study entitled as "Nursing role to improve care to infarct patients and patients undergoing
heart surgery" that (75%) were male. This study results is similar to the study of Angerud ,Brulin , Eliasson &
Naslund (2013) in an analysis of 4266 MI patient which revealed that about two third of the studied subjects
were male with mean age of 61.8 years, and Hawboldt, Pearce & Young (2010) in a study on 346 MI patients
found that, their mean age was 65.3 years and 65.5% of them were male. Moreover, Ahrens, Klinpell & Prentice
(2010) found that ACS is more prevalent in older persons than in younger persons, the condition develops earlier
in men than in women. Holle, Kirchberger, Kuch, Meisinger, Seidl& Wende (2010) also confirmed that aged
patients have a high prevalence of MI.
The study results also supported by the results of Hawboldt, Pearce& Young (2010) which studied 346
MI patients, showed that the mean age of patients was 65.4 years and almost two-thirds were male. Another
study done by Eliasson, Isaksson ,Jansson , Lundblad , Naslund& Zingmark (2011) studied 8630 with a first MI
and showed that about three fourths of the studied subjects were male with mean age of 55.5 years. In contrast
with our study, the study of Aurigemma, Chiriboga, Fornasini, Goldberg, Gore, Lessard, Spencer& Yarzebski
(2009) that studied 6334 MI patients showed that the mean age of the studied subjects was 71 years and 56%
were men.
The demographic data of present study also delineated that the majority of the studied subjects came
from urban areas. As Cairo University hospitals is one of the largest educational university hospitals in Egypt in
this field which receives the cardiac patients from all over the country. This may be due to the unhealthy
lifestyle which the urban people have comparing to the rural people lifestyle. This study results is similar to the
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study of Angerud ,Brulin, Eliasson & Naslund (2013) in an analysis of 4266 MI patient which revealed that
about two thirds of the studied subjects came from urban areas.
The present study revealed that about three fourths of the study subjects were smokers, that is why,
smoking may be the most probable risk factor for the majority of MI events. This is agreed with Gulanick &
Mayers (2011) who reported that smoking causes vasoconstriction and reduces myocardial oxygen supply , risk
for developing CAD is 2 to 6 times greater in cigarette smokers and risk is proportional to number of cigarettes
smoked. However the study carried out by Angerud , Brulin , Eliasson & Naslund (2013) showed that about one
third only of the study subjects which was 4266 MI patients were smokers.In accordance to this study, the study
of Eliasson, Isaksson , Jansson , Lundblad , Näslund & Zingmark (2011) which studied 8630 with a first MI and
showed that 39.6% of the study subjects were smokers.Moreover, Hawboldt, Pearce & Young (2010) found that
more than one third of the studied subjects (346 MI patients ) were current smokers.
The reviewed medical data sheet of current study subjects showed that more than half of them were
diagnosed STEMI. This result is similar to the results of Aurigemma, Chiriboga, Fornasini, Goldberg, Gore,
Lessard, Spencer& Yarzebski (2009) study titled “Contemporary trends in evidence-based treatment for acute
myocardial infarction” which showed that the majority of the studied subjects were STEMI. In contrast with this
study the study of Young, Hawboldt & Pearce (2010) which studied 346 MI patients found that, the majority of
the study subjects diagnosed NSTEMI.
Regarding BMI the current study showed that more than one third of the studied subjects were
overweight and more than one forth of them were obese, That’s why, the obesity may be one of the risk factors
for MI. In this regards, Brubaker, Kaminsy& Whaley (2002) reported that obesity is documented in
approximately 40% of people with CAD patients. In accordance with these results, Bucholz, Chan, Jone, Rathore,
Krumholz, Reid, Rich& Spertus (2012) in a study titled “Body mass index and mortality in acute myocardial
infarction patients” done on study sample 6359 MI patients reported that one third of the studied subjects were
obese.
Regarding the co-morbidities the current study revealed that co-morbidities was absent in one third of
the study subjects, while almost one fourths of the studied subjects had hypertension plus diabetes mellitus and
one fifth of the studied subjects had diabetes mellitus only. Gulanick & Mayers (2011) also mentioned that
eighty percent of diabetic patients have cardiovascular disease. In addition that High blood pressure is major risk
factor for CAD as Nair (2009) reported that the stress of constantly elevated blood pressure can increase the rate
of atherosclerosis development. In this regard, Aurigemma, Chiriboga, Fornasini, Goldberg, Gore, Lessard,
Spencer& Yarzebski (2009) reported that about one third of the study sample haven’t any co-morbidities, while
more than one fourth of the study sample had had 1-2 co-morbidities and about one third of them had 3-4 comorbidities. Also Bucholz et al. (2012) reported in a study done on 6359 MI patients that around two- thirds of
the sample had hypertension, and more than one third of them had diabetes mellitus. Moreover, Hawboldt,
Pearce & Young (2010) found that more than one fourth of their study subjects had had diabetes mellitus, while
more than half of them had hypertension.
As regards to the Patient's Knowledge, the current study results delineated, a higher statistically
significant difference between patient’s knowledge score pre and post exposure to the designed protocol,
indicating higher total and subtotal mean post knowledge scores among the studied subjects, ranked as
satisfactory to good levels. However, all of the studied subjects were having an unsatisfactory knowledge level
before receiving the designed protocol. The rational for knowledge improvement might be related to the
provision of educational booklet and / or verbal instructional information. Also, the curiosity of the studied
subjects as this is the first heart attack for them and many concerns are present. Results of present study showed
that there was a significant difference before and after the intervention in the studied subjects. Therefore,
applying discharge plan could have positive effects on the lifestyle of patients with MI.
Similar to the results of this research, another study by Jiang, Sit& Wong (2007) indicated that, a nurseled cardiac rehabilitation program can significantly improve the health behaviors and cardiac physiological risk
factors in coronary heart disease patients. Based on these findings, it is necessary to consider the role of nurses in
a cardiac rehabilitation program. Dalleck, Lueker& Schmidt (2011) reported that, participation in cardiac
rehabilitation programs had positive changes in various risk factors like blood pressure, cholesterol, triglyceride,
HDL and LDL cholesterol 17,18 energy expenditure, fat, and stress. Following up the client’s behavior at home
helped better controlling the heart disease. This reduced the frequency of their re-hospitalization, cost of
hospitalization and mortality rate.
Franklin, Gordon Leighton& Salmon (2002) also showed a reduction in risk factors of patients with MI,
CABG, Percutaneous coronary intervention, or angina after participating in traditional cardiac rehabilitation,
cardiac rehabilitation with physician supervision, and a community-based exercise program run by exercise
physiologists. In addition, Abedi, Ahmadi, Arefi ,Faghihi-zadeh& Ghofranipour (2005) reported that, continuous
care model has positive effects on the quality of life of patients after CABG and heart failure, in all physical,
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emotional and general dimensions. This model was effective in the reduction of the hospitalization period and
chest pain in patients with coronary vascular diseases.
However, the study carried out by Hosseini, Mohammadi, Rahgozar& Taherian (2006) aiming to
determine the effect of applying cardiac rehabilitation at home on the quality of life of patients with MI showed
that the rehabilitation program consisting of training sessions regarding MI disease and its complications, dietary
and medicinal regime, risk factors of the disease, etc. at home had no particular effect on various dimensions of
the quality of life of this group of patients and there was no significant difference between groups.
Ghahramanian, Golchin& Rostami (2011) showed that, education programs and follow-up by telephone have
positive effects on knowledge, self-care behaviors, a disease symptoms of patients with cardiac failure. Patients
forget the therapeutic recommendations gradually after discharge from the hospital; therefore, it is necessary to
provide such information. On the other hand, the number of healthy undesirable behaviors of patients with MI
increases if it is not followed-up at home. Since the patients’ participation in cardiac rehabilitation programs
after an acute MI is low, they require education and follow-up regarding the control of symptoms, medicinal
information, and improvement of lifestyle.
Chris &Charlie (2004) agreed with this findings as they studied the "Influence of written information
on patient's knowledge of their diagnosis" on 64 patients in Oxford University found that patients receiving an
information sheet were twice as likely to be correct with their main diagnosis (59% vs 31%) compared with the
control group. There was a tendency for patients receiving a sheet to have increased knowledge of previous
medical problems. Finally, patients receiving a sheet were significantly more satisfied with the information given
about their diagnosis in hospital compared with the control group.
As regards to the relationship between knowledge and educational level, the current study revealed that
there was significant statistical correlation between educational level and mean knowledge scores among studied
subjects. In this regard, Alghanim & Alnaif (2009) agreed with our findings in a published research article
entitled as "patients’ knowledge and attitudes towards health education: implications for primary health care
services" in Saudi Arabia in which they found, respondents with a higher level of education had a significantly
higher mean score (3.63) of knowledge about diabetes than those with a lower level of education (3.28) (t-test =
3.665, p<0.001). Contradicting this, Seloma (2010) reported in an unpublished doctorate thesis entitled as”
Impact of utilization of a designed nursing clinical pathway guidelines on the patients' outcomes with cardiac
pacing at the critical care units, El-Manial University Hospital” that there was no significant statistical
correlation between educational level and mean knowledge scores among study and control group subjects
throughout the different assessment periods except during assessment period before pacemaker insertion.
As regards to patient’s practice, the current study results reported that there was a significant statistical
difference between patient’s practice mean scores pre and post exposure to the designed protocol, the majority of
study subjects had higher post total and subtotal mean practice scores, ranked as satisfactory to good levels.
However, all of the studied subjects had an unsatisfactory practice scores before receiving the designed
protocol .These findings may be as a result of continuous demonstration, redemonestration, follow up and
practical content of the instructional booklet which was given to the studied subjects with the continuous
explanations, reinforcement and feedback.
In the present study, there was a significant statistical correlation between patients mean practices
scores and their level of education in different assessment periods among studied subjects before and after the
intervention. In addition to, there was a significant statistical positive correlation between total knowledge and
total practices scores among the studied subjects. Contradicting this, Seloma (2010) reported that there was no
significant statistical correlation between patients mean practices scores and their level of education in different
assessment periods among study and control group subjects. However, there was a significant statistical positive
correlation between total knowledge and total practices scores among the study and control group subjects
throughout the different assessment periods.
In accordance with the study findings, Refaii (2010) in an unpublished doctorate thesis entitled as "the
impact of a designed nursing clinical pathway guidelines on acute myocardial infarction patients' outcomes" on
60 patients (30 study and 30 control) at Benha University Hospitals in Egypt found that, an increment of study
group post mean practices scores as compared to control group after implementation of a designed nursing
clinical pathway with a highly significant statistical differences between the two groups during the two follow up
assessment (immediately post and three months later) with the following X2 &p values(X2 =21.72 at p=0.001 &
X2 = 4.158 at p =0.001 respectively). As well, El Hadary (2009) in an unpublished doctorate found that there was
a higher statistically significant difference between the study and control group subjects in different assessment
periods, indicating higher mean values of avoiding cardiac stress activities, climbing stairs as advised and
arranging activity/rest time throughout the follow up visits among the study group as compared to the control
group ones, with high significant statistical differences between them (F= 25.14 at p=0.0001, F=53.39 at
p=0.0001&F=30.70 at p=0.0001).Moreover, Mohamed (2006) in a study entitled as" effect of counseling on
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patient's compliance with therapeutic regimen after artificial valvular heart replacement surgery" on 100 patients
at the cardiothoracic surgery department at Ain Shams University hospital in Egypt, in an unpublished doctorate
thesis found that, none of the patients in the study and control groups were performing radial pulse measuring,
neck, shoulder and elbow exercises pre-program implementation. However post program implementation;
approximately one third had satisfactory performance, with a highly significant statistical difference between
study and control group subjects
As regards to patient’s compliance, the current study indicated a statistically significant difference
between the studied subjects regarding to total and subtotal compliance scores post discharge and during follow
up visits. The studied subjects showed different levels of compliance ranging between being low, medium and
high compliance levels. This may be due to continuous contact with the studied subjects through open channel of
telephone communication between the researcher and the studied subjects. Wal, Jaarsma, Moser&Veeger (2006)
mentioned that in order to improve compliance, an increment of knowledge and a change of patient's beliefs by
education and counseling are recommended. Extra attention should be paid to patients with depressive symptoms.
In this regard, El Hadary (2009) supported these result when reporting that study group subjects showed
a higher mean compliance scores regarding following prescribed medications and following prescribed activity
regimen as compared to control group subjects with significant statistical differences between the two studied
groups (F=25.60at p=0.0001& F= 69.02 at p= 0.0001).Also, Wal, Jaarsma, Moser&Veeger (2006) in a published
research article entitled as "Compliance in heart failure patients: the importance of knowledge and belief" in
University of Groningen, data were collected in a cohort of 501 heart failure patients. They found that overall
compliance was 72% in this older heart failure population. Compliance with medication and appointment
keeping was high (>90%). In contrast, compliance with diet (83%), fluid restriction (73%), exercise (39%), and
weighing (35%) was markedly lower. Compliance was related to knowledge (OR=5.67; CI 2.87-11.19), beliefs
(OR=1.78; CI 1.18-2.69), and depressive symptoms (OR=0.53; CI 0.35-0.78). Adding to that, Zerwic (2007)
stated that, the compliance to the therapeutic regimen was promoted by nursing clarification and explanation.
Therefore, the information provided through nursing intervention must be sufficient to increase patient's desire
and encourage them to comply with prescribed therapeutic regimen after discharge. The patient who are oriented
with every-thing about their disease are more likely to engage in activities that promote changing their behaviors,
promote physical well-being and enhancing the compliance with therapeutic regimen than those who are not
oriented.
8.
Conclusion
Considering the results of the present study and the available evidence, it can be concluded that, patients
who were exposed to the designed nursing protocol for the myocardial infarction patients showed a relative
improvement in their conditions than those who were exposed to the routine hospital care only. This
improvement was manifested in the increment in the post total mean knowledge scores, post total mean practice
scores and the mean compliance scores as regards to the immediate, life-long and follow up instructions.
Rehabilitation centers also could apply this model to follow the patients after MI.
9. Recommendations
Based on the findings of the present study, the following recommendations are suggested:
Recommendations related to patients:
- Establishment of patients' educational centers in hospitals equipped by suitable related materials, medias and
audio-visual aids for teaching all myocardial infarction patients' how to live with their medical condition.
- Cardiac rehabilitation centers can be established and encouraged.
- Regular follow up for all patients with myocardial infarction to evaluate their health conditions and to detect
complications early.
Recommendations for furthers researches:
- Replication of the study on a larger probability sample selected from different geographical areas in Egypt is
recommended to obtain more generalizable data.
- Further studies have to be carried out in order to assess the effectiveness of nursing intervention protocol
applications on patients' outcomes regarding different cardiac disorders.
- Further studies have to be carried out in order to assess nurses' knowledge and practices regarding providing
a nursing intervention protocol for myocardial infarction patients.
Acknowledgment
This research article would not have been possible without the support of many people. The authors
wish to express their gratitude to all people who share or help in this research.
31
8. Journal of Biology, Agriculture and Healthcare
ISSN 2224-3208 (Paper) ISSN 2225-093X (Online)
Vol.3, No.17, 2013
www.iiste.org
References
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32
9. Journal of Biology, Agriculture and Healthcare
ISSN 2224-3208 (Paper) ISSN 2225-093X (Online)
Vol.3, No.17, 2013
www.iiste.org
(A) Figures
33
10. Journal of Biology, Agriculture and Healthcare
ISSN 2224-3208 (Paper) ISSN 2225-093X (Online)
Vol.3, No.17, 2013
www.iiste.org
Figure (11): Differences in total and subtotal compliance score levels of the studied subjects’ post
receiving the designed protocol (n=40):
Compliance scores
low compliance
medium compliance
high compliance
95%
87.5%
70%
66%
50%
55%
47.5%
45%
22.5%
20%
10%
12.5%
2.5%
total compliance
0%
Patient's
Patient's
Patient's
compliance to
compliance to
compliance to
life-long
regular follow up
medication
instructions
regimen
34
7.5% 5%
2.5% 2.5%
Patient's
• Patient's
compliance to
compliance to
diet regimen exercise regimen
11. Journal of Biology, Agriculture and Healthcare
ISSN 2224-3208 (Paper) ISSN 2225-093X (Online)
Vol.3, No.17, 2013
www.iiste.org
(B) Tables:
Table (1): Distribution of the educational level, Occupation, Diet nature, Coffee intake, practicing sports
and family history for cardiac diseases for the studied subjects (n=40).
Educational level
Occupation
Diet nature
Coffee intake
Practice sports
Family history
Items
- Illiterate
- Can read and write
- Secondary education
- High education
- Doesn't work
- Worker/ Employer
- Low salt
- Low fat
- Foundry and fatty
- Not specific" usual"
- No
- Yes
- No
- Yes
- No
- Yes
No
7
15
12
6
8
32
2
1
19
19
29
11
39
1
34
6
%
17.5
37.5
30.0
15.0
20.0
80.0
5
2.5
47.5
45
72.5
27.5
97.5
2.5
85.0
15.0
Table (2): Correlation Coefficient Between total knowledge scores, total practice scores, and total
compliance scores of the studied subjects (n=40).
The Items
1-Total knowledge scores and total practice scores
2- Total practice scores and total compliance scores
3- Total compliance scores and total knowledge scores
*Significant at the p < 0.05 probability level
r/value
0.569
0.509
0.338
NS= not statistically significant
P/value
0.000*
0.001*
0.033*
Table (3): One way ANOVA test for comparison of total mean knowledge scores, total mean practice score
and total mean compliance scores in relation to educational Level of the Studied Subjects (n=40).
Variable
•
f
Educational level
10.1
o Educational level/ total mean knowledge scores
5.3
o Educational level/ total mean practice scores
4.2
o Educational level/ total mean compliance scores
*Significant at the p< 0.05 probability level
*NS= not statistically significant
35
p
0.000*
0.005*
0.011*
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