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1
Neubeck, Alicia Helen. "Increasing access to secondary prevention of cardiovascular disease." Thesis, The University of Sydney, 2011. https://hdl.handle.net/2123/27329.
Abstract:
Background: Access to secondary prevention remains disconcertingly low despite proven
benefits. The objectives of this thesis were: to evaluate telehealth models of secondary
prevention; to determine barriers to participation in secondary prevention; to evaluate the
long-term outcomes of a previously proven telehealth model, CHOICE (Choice of Health
Options In prevention of Cardiovascular Events); to determine the replicability and
generalisability of CHOICE; and to determine future directions for delivery of secondary
prevention.
Methods: Mixed methods were utilised to achieve the objectives of this thesis. To
evaluate telehealth models, a systematic review and meta-analysis process was followed.
To determine the barriers to participation in secondary prevention, a systematic review and
meta-synthesis process was followed; to evaluate the long-term outcomes of CHOICE,
patients who had participated in the original single centre trial had a repeat assessment at
four-years after their baseline assessment; to determine the replicability and generalisability
of CHOICE, a multi-centre replication trial involving 270 participants was conducted; and
to determine future directions for delivery of SP, both quantitative and qualitative methods,
including survey and focus groups, were undertaken.
Results: Telehealth based models of secondary prevention can improve access, reduce risk
factors and improve quality of life in patients who do not participate in facility-based
secondary prevention programs. While there are a number of barriers to participation in
facility-based secondary prevention, some of which are potentially modifiable, it was clear
from our review that a one-size fits all approach will not be suitable and telehealth models
can provide additional options for access to secondary prevention. Results of the long-term
follow-up of the single centre trial demonstrated that at four years participants in CHOICE had maintained the significant improvements that they had made at one year. In the current
replication study results showed that participants were at lower baseline risk than in the
previous single-centre study, but still made improvements in multiple cardiovascular risk
factors. Finally, we determined that an Internet-based model of secondary prevention
would suit some, but not all, patients with cardiovascular disease and may provide an
additional option for patients not accessing facility-based programs
Conclusion: There are multiple barriers to the uptake of secondary prevention and
telehealth models can offer an evidence-based alternative to patients who do not access
facility-based programs. The CHOICE program is a flexible telehealth model that provides
long-term behaviour change and is readily translated into multiple clinical settings. Future
work could focus on utilising new technology to increase uptake to proven secondary
prevention models such as CHOICE.
2
李雯靜 and Man-ching Anney Lee. "Effects of the disease management programme with nurse-led heart failure clinic." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B40721036.
3
Masoud, Mohamed Abdulsalam. "Validation of a recently proposed equation for the estimation of small, dense LDL particles from routine lipid measures in a population of mixed ancestry South Africans." Thesis, Cape Peninsula University of Technology, 2016. http://hdl.handle.net/20.500.11838/2490.
Abstract:
Thesis (MSc (Biomedical Technology))--Cape Peninsula University of Technology, 2016.Cardiovascular diseases (CVD) are the leading cause of global mortality, of which over 75% occurred in low- and middle-income countries such as South Africa. The lipid profile, specifically decreased levels of high density lipoprotein cholesterol (HDL-C), elevated triglyceride levels and the presence of small-dense low density lipoprotein (sdLDL) has been reported associated with CVD. An increased number of sdLDL is also common in metabolic syndrome (MetS), visceral obesity and diabetes mellitus, the last a known risk factor for CVD. The modification of low density lipoprotein (LDL) size, or number of sdLDL particles, has been reported to significantly reduce CVD risk, but not conclusively so and needs further investigation. In this regard, sdLDL particles are seldom estimated routinely for clinical use because of financial and other limitations. Currently, an alternative approach for estimating sdLDL is to use equations derived from routine lipid measures, as has been proposed by several groups. However, there is a need for extensive evaluation of this equation across different ethnic and disease groups, especially since reports showed an inadequate performance of the equation in a Korean population. The aim of this study was to assess the performance of a recently proposed equation for the estimation of sdLDL in healthy and diabetic mixed ancestry South Africans. Furthermore, we also investigated the role of sdLDL as a cardiometabolic risk factor, as measured against known risk factors such as the glycemic and lipid profiles.
4
Aachi, Venkat Raghav. "Preliminary Characterization of Mitochondrial ATP-sensitive Potassium Channel (MitoKATP) Activity in Mouse Heart Mitochondria." PDXScholar, 2009. https://pdxscholar.library.pdx.edu/open_access_etds/1667.
Abstract:
Myocardial ischemia, infarction, heart failure and arrhythmias are the manifestations of coronary artery disease. Reduction of ischemic damage is a major concern of cardiovascular biology research. As per recent studies, the mitochondrial ATP-sensitive potassium channel (mitoKATP) opening is believed to play key role in the physiology of cardioprotection, protection against ischemia-reperfusion injury or apoptosis. However, the structural information of mitoKATP is not precisely known. Elucidating the structural integrity and functioning of the mitoKATP is therefore a major goal of cardiovascular biology research. The known structure and function of the cell ATP-sensitive potassium channel (cellKATP) is functional in interpreting the structural and functional properties of mitoKATP.
The primary goal of my research was to characterize the activity of mitoKATP in the isolated mitochondria from the control mouse heart. The mitoKATP activity, if preliminarily characterized in the control strains through the light scattering technique, then the structure of the channel could possibly be established and analyzed by means of the transgenic model and with the help of immunological techniques such as western blotting and immunoflorescence.
With this experimental model it was possible to demonstrate that the mitoKATP activity in control mouse heart mitochondria is activated by potassium channel openers (KCOs) such as diazoxide and cromakalim and activators of mitoKATP such as PMA (phorbol12 myristate-13-acetate), and inhibited by KATP inhibitors such as glibenc1amide and 5-hydroxydecanoate (5 HD).
It was evident that the KATP activity in mouse heart mitochondria was comparable to that exhibited by the rat heart mitochondria. The various selective and non-selective activators and inhibitors of the channel elicited their activity at a similar concentration used for the rat heart mitochondria. The results were reproducible in five independent experiments for each combination, further reinforcing the significance of existing channel activity in the mouse heart mitochondria.
5
Purdum, Michael B. "The Effects of Positive Emotion, Negative Emotion, Flourishing, and Languishing on Cardiovascular Risk." Thesis, University of North Texas, 2010. https://digital.library.unt.edu/ark:/67531/metadc30503/.
Abstract:
Positive psychology has led a movement that concentrates on positive characteristics. The current study examined the relationship between positive emotions, negative emotions, flourishing, languishing, and cardiovascular functioning. The study uses guided imagery to help participants recall a negative emotional event and positive emotional event in a counterbalanced order. The reverse order allowed us to examine the differential contributions of stress buffering versus facilitated recovery effects to higher levels of heart rate variability (HRV). The study also examined the relationship between mental health categories and known cardiovascular disease risk. Univariate analysis of variance revealed that positive emotions can serve as a stress buffer and dampen cardiovascular responses to a negative event. Also, analysis revealed a trend for the prediction that positive emotions can facilitate cardiovascular recovery following a negative event. Exploratory analysis did not reveal differences between a facilitated recovery group and a buffering group for cardiovascular measures. Future studies should include tighter control to help compare the differential influences of stress facilitation and stress buffering on cardiovascular functioning. The results from the study indicate that it is still too early to tell whether mental health buffers those individuals from developing CVD, and to answer whether languishing increases the risk of CVD. Longitudinal studies of young individuals without a prior history of any risk of CVD and who are flourishing or languishing might help provide answers to these questions.
6
Green, Kerrie L. "A descriptive analysis of cardiac rehabilitation education programs." Virtual Press, 2000. http://liblink.bsu.edu/uhtbin/catkey/1177976.
Abstract:
The purpose of this research was to obtain information on the content of education within cardiac rehabilitation programs, methods of administering education, what the barriers are to providing education and which professionals administer education.To reach this goal, a questionnaire was modified from a previous study and a pilot study was undertaken to establish reliability of the questionnaire. The questionnaire was then sent to a sample of 100 directors of cardiac rehabilitation programs belonging to The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). The questionnaire focused on 13 established areas of education within cardiac rehabilitation programs.Once the questionnaires were completed, the information was transferred to a table format based upon the 13 content areas. The following conclusions were drawn from the research and the data gathered: 11 of the 13 content areas are offered at least 84% of the time, the major barriers for the 13 content areas were lack of time and lack of interest on the patient's behalf, the most frequent methods of education for all 13 content areas were individual education, print materials, and group education, and the primary educator overall for all 13 content areas was the nurse followed by the exercise physiologist and dietitian/nutritionist.Department of Physiology and Health Science
7
Strath, Scott J. "The effect of a light-moderate versus hard exercise intensity on health and fitness benefits." Virtual Press, 1998. http://liblink.bsu.edu/uhtbin/catkey/1115726.
Abstract:
The purpose of this study was to determine the effect of a light-moderate versus hard exercise intensity on health and fitness benefits in a previously sedentary population. Twenty-six subjects, 17 male (mean age 45 + 3 yrs), 9 female (mean age 48 + 3 yrs) with at least one coronary artery disease risk factor volunteered to participate in this study. Subjects underwent laboratory testing comprising of, resting heart rate and blood pressure, body composition, blood lipid analysis and aerobic capacity (V02 ), prior to and 22-32 weeks after participating > 2 days per week in the Adult Physical Fitness Program (APFP) at Ball State University. After an initial exercise prescription subjects self selected an exercise intensity between 40-80% of their maximal heart rate range (MHRR) at which to train. Subjects were then grouped into those who trained at < 60% (light-moderate) and those who trained at > 60% (hard) of their MHRR.Those that self selected a hard training intensity did show a significantly greater decrease in diastolic blood pressure than the light-moderate intensity group. Subjects received a main training effect with a mean decrease in systolic blood pressure (123 ± 2.8 to 119 ± 2.4 mmHg), diastolic blood pressure (78 ± 2.2 to 75 ± 1.7 mmHg), and mean increases for HDL-cholesterol (49 ± 2.5 to 53 ± 2.8 mg/dL), absolute functional capacity (2.676 +.162 to 2.843 +.169 L/min) and relative functional capacity (30.2 ± 1.5 to 32.8 + 1.8 ml/kg/min). In conclusion this study demonstrated health and fitness benefits when training at least 2 days per week with greater effects when training at a hard versus light-moderate intensity with regards to diastolic blood pressure.School of Physical Education
8
Bursill, Christina. "Green tea and its catechins modulate cholesterol metabolism in cultured human liver (HepG2) cells and the hypercholesterolaemic rabbit." Title page, contents and introduction only, 2000. http://web4.library.adelaide.edu.au/theses/09PH/09pdb9725.pdf.
Abstract:
Includes bibliographical references (21 leaves). Previous studies have found that green tea and its antitoxidant constituents, the catechins, are hypocholesterolaemic in both epidemiological and animal intervetion studies. The main objectives of the present study were to investigate the mechanism by which green tea and its most abundant catechin constituent epigallocatechin gallate increase the low-density lipoprotein (LDL) receptor of HepG2 cells. In addition, it was hoped to determine if a crude catechin extract from green tea could lower plasma cholesterol levels in the hypercholesterolaemic rabbit and ascertain if this effect was due to an increase in the LDL receptor. The study provides evidence that green tea and its catechins exhibit hypocholesterolaemic properties and may therefore provide protection against heart disease.
9
George, Siddiqah. "A critical analysis of mitochondrial functioning and associated proteins in obesity-related cardiomyopathy." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/80377.
Abstract:
Thesis (MScMedSc)--Stellenbosch University, 2013.ENGLISH ABSTRACT: INTRODUCTION: The mechanism behind obesity-related cardiomyopathies is at present not completely known, however, cardiac insulin resistance has been implicated as one of the main arbitrators of obesity-related cardiovascular disease. A few studies have associated perturbations in the insulin-mediated PI3K/PKB/Akt pathway in mediating this insulin resistance. Moreover, this pathway has been shown to regulate myocardial apoptosis, which in turn has been implicated in a number of cardiovascular diseases. Currently, few studies have compared the early onset and advanced effects of obesity on the heart. AIMS: To compare the early and advanced stages of obesity in terms of myocardial (i) PI3K/PKB/Akt signalling, (ii) apoptotic signalling and (iii) mitochondrial integrity. Furthermore, we aim to assess the cardiac mitochondrial (i) PI3K/PKB/Akt signalling, (ii) apoptotic signalling and (iii) integrity during the advanced stages of obesity. METHODS: Male Wistar rats were randomly assigned to either a control or diet-induced obesity (DIO) group. Controls were fed a standard rat chow diet and the DIO group fed a high caloric diet (standard rat chow supplemented with sucrose and condensed milk). The diets were implemented for either 8 or 20 weeks and thereafter, the body weight, intra-peritoneal fat mass, and fasting blood glucose and insulin levels (including intra-peritoneal glucose tolerance tests (IPGTTs)) were determined. Freeze-clamped hearts from both groups were subjected to cytosolic western blot analysis for PI3K p85 subunit, PKB/Akt, GSK-3α/β, Bad, Bax and Bcl-2. A fraction of each heart was also subjected to WB analysis of the mitochondrial electron transport chain (ETC) complexes (I-V). Thereafter, the above mentioned proteins were also probed for in mitochondria isolated from the 20 weeks group after administering insulin and exposing the hearts to ischemia. Oxidative phosphorylation (OXPHOS) capacity analysis was then conducted on mitochondria isolated from 20 weeks DIO and control groups and thereafter a citrate synthase (CS) activity assay was performed on these mitochondria. RESULTS: After the 8 and 20 weeks diet, the DIOs had significantly increased intra-peritoneal fat mass, fasting plasma glucose and insulin levels, compared to their controls. Cytosolic WB analysis: The tp85, pp85 and pPKB/Akt levels were significantly higher in the DIOs in comparison to the controls after 8 weeks of diet. Furthermore, pBad and Bax expression were significantly elevated in these animals. After 20 weeks of diet, the DIOs had significantly decreased pp85, tPKB/Akt and pPKB/Akt levels. The tBad was significantly elevated, while the Bad phosphorylated over total expression (P/T) ratio was significantly decreased, in these animals. CS activity assay: CS activity was significantly decreased in the DIOs, versus the controls, at 20 weeks. Mitochondrial ETC WB analysis: The subunit expression in complexes I-III and V did not differ significantly after 8 weeks however, the expression was significantly lower in complexes I and II after 20 weeks. Interestingly, the complexes III and V expression was significantly elevated. Mitochondrial OXPHOS analysis: The ADP/O ratio with (1) glutamate or (2) palmitoyl-L- carnitine as substrate, showed a significant decrease in the DIOs at 20 weeks. Mitochondrial WB analysis: The pp85 subunit was significantly elevated in the control and DIO groups, exposed to insulin and ischemia, in comparison to the untreated controls. The Bcl-2 levels were significantly decreased in the insulin and ischemia DIOs, when matched against the untreated DIOs. The tBad expression did not differ significantly between the insulin and untreated controls, while the tBad was significantly augmented in the ischemia controls versus untreated controls. All significant differences were taken as p<0.05. CONCLUSION: The results indicate that the initial stage of diet-induced obesity is associated with cardioprotection as there is augmented PI3K/PKB/Akt pathway signalling and a decrease in apoptotic markers. In contrast, during the advanced stages of obesity a decreased activity in PI3K/PKB/Akt pathway is associated with myocardial apoptosis and decreased mitochondrial function and integrity.
AFRIKAANSE OPSOMMING: INLEIDING: Die meganisme verantwoordelik vir vetsug-verwante kardiomiopatieë is huidiglik nie bekend nie maar kardiale insulienweerstandigheid word geïmpliseer as een van die hoof bemiddelaars van vetsug-verwante hartsiektes. Verskeie studies het versteurings in die insulien-gemediëerde PI3K/PKB/Akt pad geassosieer met die bevordering van hierdie insulienweerstandigheid. Daarbenewens is dit getoon dat hierdie pad betrokke is in die regulering van miokardiale apoptose, wat op sy beurt geïmpliseer is in 'n aantal kardiovaskulêre siektes. Daar is tans min studies beskikbaar wat die vroeë en laat gevolge van obesiteit op die hart vergelyk. DOELWITTE: Om die vroeë en gevorderde stadiums van vetsug te vergelyk in terme van miokardiale (i) PI3K/PKB/Akt seintransduksie, (ii) apoptotiese seintransduksie en (iii) mitokondriale integriteit. Verder, het die studie ten doel om die kardiale mitokondriale (i) PI3K/PKB/Akt en (ii) apoptotiese seintransduksie en (iii) integriteit in die gevorderde stadiums van vetsug te bepaal. METODES: Manlike Wistar rotte is ewekansig toegewys aan óf 'n kontrole of dieet-geïnduseerde vetsug (DIO) groep. Kontroles is met 'n normale rotkos dieet en die DIO groep met 'n hoë kalorie dieet (normale rotkos aangevul met sukrose en kondensmelk) gevoed. Die dieet is vir 8 of 20 weke volgehou en daarna was die liggaamsgewig, intra-peritoneale vet massa, en vastende bloed glukose en insulien vlakke (insluitende intra-peritoneale glukose toleransie toets (IPGTT`s)) bepaal. Gevriesklampte harte van beide groepe is onderwerp aan sitosoliese WB-analise vir die PI3K p85 subeenheid, PKB / Akt, GSK-3α/β, Bad, Bax en Bcl-2. `n Fraksie van hierdie harte is ook onderwerp aan westerse klad analise (WK-analise) van die mitokondriale elektron vervoer ketting (EVK) komplekse (I-V). Daarna is bogenoemde proteïene ondersoek in mitokondrieë geïsoleer uit die 20 weke groep ná die toediening van insulien en die blootstelling van die harte aan iskemie. Die oksigraaf mitokondriale oksidatiewe fosforilering (OXPHOS) kapasiteit analise is dan op mitokondrieë van 20 weke DIO en kontrole groepe uitgevoer en daarna is 'n sitraatsintase (SS) aktiwiteitstoets gedoen. RESULTATE: Na die 8 en 20 weke dieet, het die intra-peritoneale vet massa, vastende plasma glukose en insulien vlakke in die DIOs aansienlik toegeneem, in vergelyking met hul kontroles. Sitosoliese WK-analise: Die tp85, pp85 en pPKB/Akt vlakke was beduidend hoër in die DIOs in vergelyking met die kontroles, na 8 weke van die dieet. Verder is die pBad en Bax vlakke beduidend verhoog in hierdie diere. Na 20 weke van die dieet, het die pp85, tPKB/Akt en pPKB/Akt vlakke beduidend afgeneem in die DIOs, in vergelyking met die kontroles. Die tBad was beduidend verhoog, terwyl die Bad verhouding van gefosforileerde oor die totale proteïen uitdrukking (P/T)-verhouding) beduidend verminder het in hierdie diere. SS aktiwiteitstoets: SS aktiwiteit is beduidend verminder in die DIOs, teenoor die kontroles, op 20 weke. Mitokondriale EVK WK-analise: Die subeenheid uitdrukking in komplekse I-III en V was nie beduidend verskillend na 8 weke nie. Na 20 weke egter, was die uitdrukking aansienlik laer in komplekse I en II. Interessant genoeg, is die uitdrukking aansienlik verhoog in komplekse III en V. Mitokondriale OXPHOS analise: Die ADP/O verhouding met (1) glutamaat of (2) palmitiel-L-karnitien as substraat, het beduidend afgeneem in die DIOs teen 20 weke. Mitokondriale WK-analise: Die pp85 subeenheid was beduidend verhoog in die kontrole en DIO groepe, blootgestel aan insulien en iskemie, in vergelyking met die onbehandelde kontroles. Die Bcl-2 vlakke was beduidend verminder in die insulien en isgemie DIOs, in vergelyking met onbehandelde DIOs. Die tBad uitdrukking het nie beduidend verskil tussen die insulien en onbehandelde kontroles nie, terwyl die tBad beduidend verhoog was in die isgemie kontroles versus onbehandelde kontroles. Alle beduidende verskille is geneem as p<0.05. GEVOLGTREKKING: Die resultate dui daarop dat die eerste fase van dieet-geïnduseerde obesiteit geassosieer is met kardiale beskerming want `n toename in PI3K/PKB/Akt seintransduksie en 'n afname in apoptotiese merkers is waargeneem. In teenstelling, in die gevorderde stadium van vetsug is daar 'n afname in aktiwiteit in die PI3K/PKB/Akt pad wat verband hou met verhoogde miokardiale apoptose en verminderde mitokondriale funksie en integriteit.
10
Konicki, Annette Jakubisin. "Women’s Knowledge of Cardiovascular Risk Factors, Level of Self-Nurturance and Participation in Heart-Healthy Behaviors: A Dissertation." eScholarship@UMMS, 2009. https://escholarship.umassmed.edu/gsn_diss/11.
Abstract:
The number one killer of women in the United States is cardiovascular disease (CVD). Cardiovascular risk factors (CVRFs) include advancing age, cigarette smoking, diabetes, dyslipidemia, family history, hypertension, obesity, sedentary lifestyle and high intake of saturated fats and low dietary fiber. A women’s risk for development of CVD dramatically increases after menopause and with the number of CVRFs. CVD is often preventable. Evidence supports addressing CVRFs reduction early (in the pre-menopausal years) through heart-healthy behaviors such as increasing physical activity, promoting healthy eating, moderate alcohol consumption and not smoking. Therefore, understanding premenopausal women’s CVRFs knowledge is an important area of inquiry. In addition, the Nemcek Wellness Model suggests that self-nurturance, as well as knowledge, may be an important factor for explaining women’s wellness behaviors. Thus, the purpose of this study was to investigate knowledge of CVRFs, level of self-nurturance and the performance of heart-healthy behaviors in women ages 35 to 55 years.
This study used a cross sectional survey design and venue sampling. The survey included demographic questions, the Self Nurturance Survey, the Heart Disease Facts Questionnaire, the Physical Activity Questionnaire, Prime Screen, and questions about financial strain, cigarette smoking, and alcohol use. The sample included 136 women (survey response rate = 57%), the majority of whom were white (94.9%), married (80.1%), did not smoke (80.1%) and rarely drank alcohol (57.4%).
Results indicated that study participants were very knowledgeable about CVRFs. (Mean knowledge score = 19.53, possible range = 0 to 25 with higher scores indicating greater knowledge). Knowledge did not predict physical activity (p = .07), diet (p = .08) or smoking status (p = .11) in this sample. Self-nurturance was moderately correlated (r = .33) with consuming a heart-healthy diet. Hypotheses derived from the Nemcek Wellness Model were not supported in this study. More research is needed to identify factors that will help women translate knowledge into heart-healthy behaviors.
11
Chau, June, and 周宗欣. "Application of cost-effectiveness concepts to cardiac rehabilitation and secondary prevention in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2001. http://hub.hku.hk/bib/B31225755.
12
Wong, Mei-fung Florence, and 王美鳳. "The effectiveness of audiovisual intervention in reducing anxiety of patients undergoing cardiac catheterisation: a critical review." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2007. http://hub.hku.hk/bib/B45012179.
13
Haghshenas, Abbas Public Health & Community Medicine Faculty of Medicine UNSW. "Negotiating norms, navigating care: the practice of culturally competent care in cardiac rehabilitation." Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2006. http://handle.unsw.edu.au/1959.4/32280.
Abstract:
BACKGROUND Increasingly, it is recognised that the unique needs of people from culturally and linguistically diverse backgrounds (CaLDB) should be addressed within a framework of cultural competence. To date, there are limited data on the issues facing CaLDB patients in the Cardiac Rehabilitation (CR) setting. Appreciation of an individual???s values, attitudes and beliefs underpins negotiation of behaviour change in the CR setting. Therefore an understanding of patient and professional interactions is of key importance. OBJECTIVES The focus of this study has been to undertake an exploration of CR service delivery to people from culturally and linguistically diverse backgrounds, using Arabic speaking people as an exemplar of a CaLDB group. More broadly, this research project has sought to identify factors, which influence the practice of health professionals towards CaLDB patients, and to develop a model for evaluation of culturally competent health care in the CR setting. The study sought to achieve these aims by addressing the following research questions: 1. In what way do health practitioners in CR adjust their treatment and support to accommodate the perceived needs of CaLDB communities? 2. In what way do factors (such as individual and organisation perspectives) influence the adjustment of clinical practice and service delivery of CR practitioners; and what are practitioners??? and patients??? perception of barriers and facilitators to service delivery? 3. To what level are CaLDB patients satisfied with CR services? This study design is comprised of the following elements: (1) interviews with health practitioners and Arabic speaking background patients as an exemplar of CaLDB patients; (2) review of policy and procedure documents and medical records; and (3) field observation. METHOD This thesis embraces a qualitative approach as the primary method of investigation to align with the exploratory and descriptive nature of the study. The main methods used in the study were: in depth interviews with health professionals and patients; field observations; appraisal of relevant documents and consultation with expert panels. Study samples were selected through a purposive sampling strategy.Data were analysed using the method of content analysis, guided by the research questions. FINDINGS In total, 25 health professionals (20 female and 5 male) and 32 patients (21 male and 11 female) were interviewed. The method of qualitative content analysis was used for data analysis. Data analysis revealed four major themes: 1) The challenging context; 2) Tuning practices; 3) Influencing factors; and 4) Goodness of fit. The study demonstrated a challenging context for CR delivery, both from the perspective of patients and health professionals. Data reveal a process of reflection, negotiation, and navigation of care by CR health professionals in an effort to understand and meet the diverse needs of CALDB patients. CONCLUSION On the basis of the study findings, a process-oriented model of tuning practice to achieve cultural competence in CR delivery is proposed to inform policy, research and clinical practice.
14
Humble, Kelly Marie. "Idiopathic Cardiomyopathy: Case Study of a Female College Basketball Player." PDXScholar, 2011. https://pdxscholar.library.pdx.edu/open_access_etds/1685.
Abstract:
The objective of the current study is to present the case of an intercollegiate basketball player diagnosed with an ifliopathic cardiomyopathy. The athlete illustrated in the case study experienced ongoing chest discomfort with exercise. Episodic chest pain and syncope in athletes is often alarming and may signal an underlying cardiac condition. Early recognition and maJagement of these athletes is vital to the prevention of sudden cardiac death (SCD). Fortunately, the athlete was referred to a cardiologist by her team physician during her pre-participation physical examination to rule out heart conditions that may lead to SCD.
The athlete was presented a mildly reduced ejection fraction during her screening with the cardiologist. In cardiovascular physiology, ejection fraction is the fraction of end-diastolic volume that is ejected from the ventricle with each heart beat. Damage to the myocardium, as seen in cardiomyopathies, decreases the heart's ability to eject blood and therefore reduces the ejection fraction. The athlete underwent VO2max testing as well where it was discovered that her VO2max was exceptionally low for a physically active division-I athlete. This low VO2max suggested that the athlete had an insufficient oxygen uptake during intense exercise.
The athlete experienced a treatment protocol consisting of a progressive conditioning regimen of additional cardiovascular exercise that proved to be effective in raising her VO2max by 10%. The athlete returned to full participation and remained asymptomatic throughout the remainder of the season.
The pre-participation physical examination is crucial in early detection of events that may lead to sudden cardiac death. A thorough history and physical examination are the most efficient screening methods for detecting cardiovascular abnormalities. Any athlete with episodes of syncope, hypertension, or changes in heart rhythm should be referred to a physician.
15
吳石光 and Shek-kong Sandor Ng. "An evidence-based guideline of using music therapy for patients undergoing cardiac catheterisation." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193032.
Abstract:
Coronary artery disease (CAD) is known as the second killer in Hong Kong. The Hong Kong Hospital Authority reported nearly 7000 patients suffered from acute myocardial infarction (AMI) in year 2010 to 2011. Percutaneous transluminal coronary angioplasty (PTCA) is a minimal access surgical treatment for coronary artery disease but studies have shown that patients experienced different levels of anxiety before and during PTCA which led negative impact to the patients. Music can be regarded as a safe, cost-effective therapy to reduce one’s anxiety level. It can be carried out by nurses without any specific technique. However, there was no systemic review for using music therapy to patients undergoing PTCA. Therefore, this dissertation aims to evaluate the best available evidence on using music therapy for patients undergoing PTCA.
Four electronic databases, Medline, CINAHL, Embase & PsycINFO, were searched for studies to investigate the efficacy of music therapy in patients undergoing PTCA. There were seven studies were eligible with data extracted and quality assessment performed by the critical appraisal skill programme (CASP) checklist. Four studies were graded as high quality, which consistently demonstrated a statistically significant more reduction in the anxiety level of patients who received music therapy either before and/or during PTCA than those who had no music therapy.
Consequently, an evidence-based guideline of using music therapy for patients undergoing PTCA was developed according to the guideline development process of SIGN (2010). The use of music therapy is transferable and feasibly in the local setting with little manpower concern. The total cost estimated for running the innovation for a year was HKD 83,775 which was considered as cost-effective to reduce patients’ anxiety level and avoid associated adverse events.
A 14-months programme including communication with the stakeholders, pilot testing, staff training and clinical application of the proposed music therapy was designed. Qualitative and quantitative data on patient, healthcare provider and system outcomes would be accounted throughout the programme. The effectiveness of the guideline would be determined by the reduction of patient’s anxiety level by using the Chinese version of State-Trait Anxiety Inventory (STAI) (Shek, 1993). Moreover, healthcare provider outcome would be evaluated by questionnaire and the expenditure of the proposed music therapy would be monitored closely.published_or_final_version
Nursing Studies
Master
Master of Nursing
16
Esterhuyse, Adriaan Johannes. "Dietary red palm oil-supplementation offers cardioprotection against Ischaemia/Reperfusion injury : possible cellular mechanisms involved." Thesis, Stellenbosch : University of Stellenbosch, 2005. http://hdl.handle.net/10019.1/16514.
Abstract:
Dissertation (PhD)--University of Stellenbosch, 2005.ENGLISH ABSTRACT: Activation of the NO-cGMP pathway is associated with myocardial protection against ischaemia/reperfusion injury. However, high-cholesterol diets alter function of this pathway and these alterations have been implicated in both ischaemic/reperfusion injury and the development of ischaemic heart disease. Little is known about the effects of supplements such as Red Palm Oil (RPO) on the myocardial NO-cGMP-signalling pathway. RPO consists of saturated, mono-unsaturated and poly-unsaturated fatty acids and is rich in antioxidants such as β-carotene and Vitamin E (tocopherols and tocotrienols). The aims of this study were: 1) to determine whether dietary RPO-supplemention protects against ischaemia/reperfusion injury in rats fed a standard rat chow (control) and cholesterol-enriched diets and 2) if so, to investigate possible mechanisms for this protection. Male Long-Evans rats were fed a standard rat chow or a standard rat chow plus cholesterol and/or RPO-supplementation for 6 weeks. Myocardial functional recovery was measured and hearts were freeze-clamped for determination of myocardial phospholipid, cAMP/cGMP concentrations, total myocardial nitric oxide concentrations, lipid hydroperoxide production and superoxide dismutase- and nitric oxide synthase activity in isolated rat hearts subjected to 25 minutes of normothermic total global ischaemia. In addition, the degree of phosphorylation of extracellular signal-regulated kinase (ERK), p38, c-Jun N-terminal protein kinase (JNK) and protein kinase B (PKB/Akt) was investigated. Furthermore, the effect of RPO-supplementation on caspase-3 activation and poly (ADP-ribose) polymerase (PARP)-cleavage in hearts subjected to ischaemia and reperfusion was also investigated. Our data show that dietary RPO-supplementation protects the hearts of rats on a standard rat chow (control) and hypercholesterolaemic diet against ischaemia/reperfusion injury as reflected by improved aortic output recovery. Increased intracellular cardiomyocyte NO concentrations as observed in control hearts supplemented with RPO after 120 minutes hypoxia may contribute to the elevated cGMP concentration and may confer some of the cardioprotection to the ischaemic/reperfused heart. Although improved functional recovery with RPO-supplementation of a high-cholesterol diet was also associated with an increase in intracellular cardiomyocyte NO production after hypoxia compared to the non-hypoxic conditions, it could not be linked to increased NO-cGMP signalling. These data are in agreement with other studies, which showed that high-cholesterol diet impairs NO-cGMP signalling and confirms our hypothesis that elevated cGMP concentrations may not be the only mechanism of protection. We have also shown that RPOsupplementation caused increased phosphorylation of p38 and PKB, reduced phosphorylation of JNK and attenuation of PARP cleavage, which may contribute to the protection of the cell against apoptosis. Based on our results we propose that the myocardial protection offered by RPO-supplementation of rats on a normal and hypercholesterolaemic diet may be associated with either its antioxidant characteristics and/or changes in the fatty acid composition of the myocardium during ischaemia/reperfusion. Furthermore, we demonstrated for the first time that RPO-supplementation protects the isolated perfused working rat heart during reperfusion from ischaemia/reperfusion-induced injury through a MAPK-dependent pathway.
AFRIKAANSE OPSOMMING: Aktivering van die NO-cGMP sein transduksie pad word geassosieer met miokardiale beskerming teen isgemie/herperfusie skade. Hoë cholesterol diëte verander egter die funksie van die pad en hierdie veranderings speel ‘n rol in beide isgemie/herperfusie besering en die ontwikkeling van isgemiese hartsiekte. Daar is egter min inligting beskikbaar oor die uitwerking van aanvullings soos rooi palm olie (RPO) op die miokardiale NO-cGMP sein transduksie pad. RPO bevat versadigde, mono-onversadigde en poli-onversadigde vetsure en is ryk aan anti-oksidante nl. β-karotene en vitamien E (tokoferole en tokotriënole). Die doelwitte van hierdie studie was: 1) om vas te stel of ‘n RPO-aanvulling beskerming bied teen isgemie/herperfusie besering in rotte wat gevoed is met ‘n standaard rotmengsel (kontrole) en cholesterol-verrykte dieet en 2) indien wel, om moontlike meganismes van beskerming te ondersoek. Long-Evans manlike rotte is vir 6 weke gevoer met ‘n standaard rotmengsel of ‘n standaard rotmengsel plus cholesterol en/of RPO-aanvulling. Miokardiale funksionele herstel is gemeet en harte is gevriesklamp vir die bepaling van miokardiale fosfolipied, cAMP/cGMP, totale stikstofoksied, lipied hidroperoksied, superoksied dismutase en stikstofoksied sintase in geïsoleerde rotharte wat vir 25 minute onderwerp was aan normotermiese totale globale isgemie. Hiermee saam is die graad van fosforilering van ekstrasellulêre sein gereguleerde kinase (ERK), p38 mitogeen-geaktiveerde proteïen kinase (p38 MAPK), c-Jun-N-terminale proteïenkinase (JNK) en proteïen kinase B (PKB/Akt) ondersoek, asook kaspase-3 aktivering en poli (ADP-ribose) polimerase (PARP) kliewing in harte blootgestel aan isgemie en herperfusie. Ons resultate toon dat RPO-aanvulling van rotte op ‘n normale en hipercholesterolemiese dieet die hart beskerm soos getoon deur verbeterde herstel van aortiese uitset. Verhoogde intrasellulêre miokardiale NO vlakke in kontrole harte met ‘n RPO-aanvulling wat blootgestel was aan 120 minute hipoksie, mag bygedra het tot die verhoogde cGMP vlakke en beskerming van die hart tydens isgemie en herperfusie. Alhoewel verbeterde funksionele herstel met RPO-aanvulling van ‘n hoë cholesterol dieet ook geassosieer is met ‘n toename in intrasellulêre miokardiale NO produksie ná hipoksiese toestande, kon dit nie verbind word met verhoogde aktivering van die NOcGMP sein transduksie pad nie. Hierdie resultate stem ooreen met ander studies wat aangetoon het dat hoë-cholesterol diëte die NO-cGMP seinpad onderdruk. Hierdie bevinding bevestig ons hipotese dat verhoogde cGMP vlakke moontlik nie die enigste beskermingsmeganisme is nie. Ons resultate het ook gewys dat RPO-aanvulling fosforilering van p38 en PKB/Akt verhoog, fosforilering van JNK verminder en PARP kliewing onderdruk. Dit dui op beskerming van die sel teen apoptose. Ons resultate dui aan dat die miokardiale beskerming wat RPO-dieet aanvulling bied moontlik geassosieer kan word met sy anti-oksidant eienskap en/of veranderinge in die vetsuur samestelling van die miokardium tydens isgemie/herperfusie. Ons het ook vir die eerste keer bewys dat RPO-aanvulling die geïsoleerde geperfuseerde werkende rothart gedurende herperfusie beskerm teen isgemie/herperfusie besering deur die aktivering en/of deaktivering van die MAPK afhanklike pad.
17
Hajduk, Alexandra M. "Cognitive Status and Initiation of Lifestyle Changes Following Acute Coronary Heart Syndrome: A Dissertation." eScholarship@UMMS, 2014. https://escholarship.umassmed.edu/gsbs_diss/701.
Abstract:
Background: Cognitive impairment is prevalent in survivors of acute coronary syndrome (ACS) and increases risk for poor outcomes. Lifestyle changes are recommended to patients after ACS to reduce their risk for recurrent events, but cognitively impaired patients may encounter difficulties initiating these changes. This dissertation had three aims: (1) to examine cognitive status as a predictor of lifestyle changes after ACS, (2) to examine whether caregiver support moderates the association of cognitive status and initiation of lifestyle changes, and (3) to assess the reliability of self-reported lifestyle changes in cognitively impaired patients through comparison of their reports of lifestyle change with those from their caregivers.
Methods: For aims 1 and 2, Poisson regression with robust error variance was used to examine the association of cognitive status and caregiver support with patient-reported initiation of five lifestyle changes (improving diet, increasing exercise, quitting smoking, reducing stress, and attending cardiac rehabilitation) in 881 patients from TRACE-CORE, a prospective longitudinal observational study of outcomes in ACS. For aim 3, pilot data from 78 patient-caregiver dyads from TRACE-CARE, an ancillary substudy, were used to examine whether patient-caregiver congruence on reports of lifestyle changes varied according to patients’ cognitive function.
Results: Patient-reported rates of lifestyle change did not vary according to cognitive status, except for participation in cardiac rehabilitation. Caregiver support improved patient-reported rates of lifestyle change among cognitively intact patients but not cognitively impaired patients. Patients’ cognitive function was positively associated with patient-caregiver congruence on reports of initiation of lifestyle changes and patients with decreased cognitive function tended to over-report initiation of lifestyle changes compared to reports by their caregivers.
Conclusion: Although cognitive status was not associated with initiation of most lifestyle changes and the influence of caregiver support on initiation of lifestyle changes was only beneficial to cognitively intact patients in this cohort of ACS patients, these null findings may be explained by the questionable validity of self-report in cognitively impaired patients. This dissertation yields new knowledge about secondary prevention in ACS patients and provides insight into the challenges of conducting patient-reported outcomes research in cognitively compromised populations.
18
Hajduk, Alexandra M. "Cognitive Status and Initiation of Lifestyle Changes Following Acute Coronary Heart Syndrome: A Dissertation." eScholarship@UMMS, 2003. http://escholarship.umassmed.edu/gsbs_diss/701.
Abstract:
Background: Cognitive impairment is prevalent in survivors of acute coronary syndrome (ACS) and increases risk for poor outcomes. Lifestyle changes are recommended to patients after ACS to reduce their risk for recurrent events, but cognitively impaired patients may encounter difficulties initiating these changes. This dissertation had three aims: (1) to examine cognitive status as a predictor of lifestyle changes after ACS, (2) to examine whether caregiver support moderates the association of cognitive status and initiation of lifestyle changes, and (3) to assess the reliability of self-reported lifestyle changes in cognitively impaired patients through comparison of their reports of lifestyle change with those from their caregivers.
Methods: For aims 1 and 2, Poisson regression with robust error variance was used to examine the association of cognitive status and caregiver support with patient-reported initiation of five lifestyle changes (improving diet, increasing exercise, quitting smoking, reducing stress, and attending cardiac rehabilitation) in 881 patients from TRACE-CORE, a prospective longitudinal observational study of outcomes in ACS. For aim 3, pilot data from 78 patient-caregiver dyads from TRACE-CARE, an ancillary substudy, were used to examine whether patient-caregiver congruence on reports of lifestyle changes varied according to patients’ cognitive function.
Results: Patient-reported rates of lifestyle change did not vary according to cognitive status, except for participation in cardiac rehabilitation. Caregiver support improved patient-reported rates of lifestyle change among cognitively intact patients but not cognitively impaired patients. Patients’ cognitive function was positively associated with patient-caregiver congruence on reports of initiation of lifestyle changes and patients with decreased cognitive function tended to over-report initiation of lifestyle changes compared to reports by their caregivers.
Conclusion: Although cognitive status was not associated with initiation of most lifestyle changes and the influence of caregiver support on initiation of lifestyle changes was only beneficial to cognitively intact patients in this cohort of ACS patients, these null findings may be explained by the questionable validity of self-report in cognitively impaired patients. This dissertation yields new knowledge about secondary prevention in ACS patients and provides insight into the challenges of conducting patient-reported outcomes research in cognitively compromised populations.
19
Huang, Xiao Hui. "Protective effects of sodium tanshinone II A sulfonate against sunitinib induced cardiotoxicity in H9c2 cell and zebrafish." Thesis, University of Macau, 2014. http://umaclib3.umac.mo/record=b3132193.
20
Bricknell, Martin Charles Marshall. "The prevention of heart illness in the British Army." Thesis, University of Southampton, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.302346.
21
Wrigley, Martha J. "Engaging families with a premature family history of heart disease : a primary prevention study for coronary heart disease." Thesis, University of Southampton, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.485524.
Abstract:
This thesis focuses upon a preventative approach for people with a familial history of premature coronary heart disease. The research study had two aims; firstIy to understand the experience of individuals when their parent or sibling had been diagnosed with heart disease; secondly to develop and evaluate a primary prevention health promotion programme for these people. The thesis provides unique insight into their personal experiences of living with tIris familial diagnosis and gives details of how this population can be identified and involved successfully in a health promotion programme. The study was conducted in a district general hospital; 28 people were recruited of whom 20 participants completed the two year study. Narrative interviews were conducted at the beginning and end of the study, providing insight into people's personal experience. Salutogenesis is the theoretical framework in which the narratives are discussed; from these health resources are identified which can enhance people's progress and maintenance for a healthy lifestyle. The health promotion programme has established, developed and evaluated a nurseled and doctor supported primary pjevention strategy. Education and support was provided in the programme for individuals and families. The participants' physical and behavioural changes were reviewed six monthly, for two years. People are aware of risk factors associated with heart disease, but still seek professional support and advice in relation to their own lifestyle and behaviour. Individual lifestyle changes were achieved by most participants, which translated into significant findings for blood pressure and alcohol consumption; positive changes were seen in physical activity, smoking, diet and psychosocial stress. There were no improvements in lipid profiles. The need for a preventatiye approach in health care, which includes primordial and primary prevention for heart disease, is discussed. The issues in this thesis are reflective upon current government focus to develop preventative health services which actively engage with people as integral to this process. The thesis discusses coronary heart disease, the roles of prevention and health promotion, and identifies health resources for people at high-risk of future cardiovascular problems.
22
Garbenienė, Henrieta. "Širdies ir kraujagyslių ligų prevencijos programos efektyvumo vertinimas Šiaulių mieste." Master's thesis, Lithuanian Academic Libraries Network (LABT), 2011. http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2011~D_20110705_131833-35858.
Abstract:
Širdies ir kraujagyslių ligos Lietuvoje kaip ir visame pasaulyje yra dažniausia mirtingumo priežastis. Pasiekti geresnių sveikatos rodiklių galima įtraukiant kuo daugiau gyventojų į sveiką gyvenseną skatinančias programas, tačiau svarbi visuma - programas reikalinga ir tinkamai valdyti.
Darbo tikslas - įvertinti širdies ir kraujagyslių ligų prevencijos programos vykdymo efektyvumą Šiaulių mieste.
Darbo uždaviniai: Išnagrinėti Asmenų, priskirtų širdies ir kraujagyslių ligų didelės rizikos grupei, atrankos ir prevencijos priemonių finansavimo programos reikalingumą, Lietuvos teisės aktus, reglamentuojančius programos įgyvendinimą. Išanalizuoti sergamumo ir mirtingumo nuo širdies ir kraujagyslių ligų duomenis ir statistikos rezultatus bei įvertinti programos įgyvendinimo situaciją Lietuvoje ir Šiauliuose. Įvertinti širdies ir kraujagyslių programos efektyvumą jos vartotojų ir vykdytojų požiūriu Šiaulių mieste ir pateikti programai pasiūlymus.
Tyrimo objektas: Asmenų, priskirtų širdies ir kraujagyslių ligų didelės rizikos grupei, atrankos ir prevencijos priemonių finansavimo programa.
Tyrimo dalykas: Asmenų, priskirtų širdies ir kraujagyslių ligų didelės rizikos grupei, atrankos ir prevencijos priemonių finansavimo programos efektyvumas, įgyvendinimas bei problemos.
Darbo metodai: aprašomasis, palyginamosios analizės, istorinis, ir 3 sociologiniai tyrimai: kokybinis gydytojų ir pacientų nuomonės tyrimas ir kokybinis tyrimas – pusiau struktūruotas ekspertų interviu.
Išvados:... [toliau žr. visą tekstą]Heart and vascular diseases are the most frequent cause of mortality in Lithuania as well as in the whole world. It is possible to achieve better health rates involving as many people into programs encouraging and stimulating healthy lifestyle as possible, however the totality is also important – it is also necessary to manage appropriately the programs. Objective of the paper - to assess the efficiency of performance of the prevention program of heart and vascular diseases in Šiauliai City. Tasks of the paper: To consider the necessity of the program of financing of the measures of selection and prevention of people attributed to the group of high risk of heart and vascular diseases, as well as to analyse Lithuanian law acts regulating implementation of the program. To analyse data and statistical results on morbidity and mortality caused by cardiovascular diseases as well as to assess the situation of the program implementation in Lithuania and Šiauliai. To assess the efficiency of the program of cardiovascular diseases from the point of view of the users and implementers thereof as well as to give suggestions and advises to the program. Object of the research: the program of financing of selection and prevention measures of people attributed to the group of high risk of cardiovascular diseases. Subject of the research: the efficiency, implementation and problems of the program of financing of the selection and prevention measures of people attributed to the group... [to full text]
23
Shaw, I., BS Shaw, and GA Brown. "Influence of strength training on cardiac risk prevention in individuals without cardiovascular disease." African Journal for Physical, Health Education, Recreation and Dance, 2009. http://encore.tut.ac.za/iii/cpro/DigitalItemViewPage.external?sp=1001650.
Abstract:
Abstract
It has widely been shown that exercise, particularly aerobic exercise, has extensive cardioprotective
benefits and is an important tool in the prevention of coronary heart disease (CHD). The present
investigation aimed to determine the multivariate impact of strength training, designed to prevent the
development of CHD, on the Framingham Risk Assessment (FRA) score. Twenty-eight healthy
untrained men with low CHD risk (mean age 28 years and 7 months) participated in an eight-week (3-
d/wk) strength training programme. Self-administered smoking records, resting blood pressures, total
cholesterol (TC), high-density lipoprotein cholesterol (HDLC), FRA scores and absolute 10-year risks
for CHD were determined at the pre-test and post-test. After the eight-week period, no significant (p >
0.05) differences were found in number of cigarettes smoked daily, systolic blood pressure, TC, HDLC,
FRA scores and absolute 10-year risks for CHD in both the strength-trained (n = 13) and non-exercising
control (n = 15) groups. The data indicate that strength training did not reduce the risk of developing
CHD and absolute 10-year risk for CHD as assessed by the FRA score.
24
Rees, Lois. "The provision of disease prevention services from community pharmacies." Thesis, University College London (University of London), 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.339279.
25
Love, Thomas. "trends in the Secondary Prevention of Heart Disease in Primary Care." Thesis, University of Dundee, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.500641.
26
Rodrigues, Do Espirito Santo Karla. "Mobile Communication Technologies to Improve Secondary Prevention of Coronary Heart Disease." Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/18501.
Abstract:
Coronary heart disease (CHD) is the leading cause of death worldwide. Prevention strategies are extremely important to reduce the burden of CHD, especially in those who have had a previous cardiovascular event, as they are at greater risk of having a recurrent event and are more likely to die in the recurrent event. Despite the clear benefits of preventive care, many CHD patients fail to receive and adhere to the guideline recommendations, including lifestyle modification and adherence to evidence-based medications. Prevention programmes, such as cardiac rehabilitation, are effective in improving CHD morbidity and mortality. However, such programmes are under-utilised due to several barriers. Therefore, there is a need for innovative approaches in CHD preventive care. The use of mobile communication technologies in healthcare, often termed mHealth, presents a promising strategy to deliver prevention interventions to large numbers of people. This thesis aimed to investigate the use of mobile communication technologies to improve secondary prevention of CHD. Findings of this thesis suggest that mHealth can improve healthcare by delivering preventive interventions to patients with CHD. Two potential modes of preventive programme delivery are text-messages and smartphone applications (apps). A lifestyle-focused text-messaging intervention investigated in the TEXT ME Study was found to be effective in improving heart-healthy dietary patterns in patients with CHD. In addition, the use of medication reminder apps was shown to improve medication adherence in patients with CHD and no significant differences were found between an advanced and a basic medication reminder apps. In conclusion, mHealth interventions improved both lifestyle modification and medication adherence components of secondary prevention of CHD. Future research is needed to confirm and expand these findings in larger longer-term RCTs.
27
Leong, Yuk-yan Pauline, and 梁玉恩. "The effectiveness of exercise-based cardiac rehabilitation program for secondary prevention of coronary heart disease : a systematic review." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193828.
Abstract:
Objective: To examine the effect of exercise-based cardiac rehabilitation program for secondary prevention of coronary heart disease on cardiac-related mortality, recurrent cardiovascular event and quality of life.
Methods: All studies published between 1990 and 2013 in PubMed, and from 1980 to 2013 in EMBASE, which evaluated the effectiveness of exercise-based cardiac rehabilitation program for coronary heart disease. Using the specific keywords “Cardiac rehabilitation”, “Coronary heart disease” OR “Ischemic heart disease” [MeSH], “Exercise” OR “Physical activities” AND “Quality of life” OR “Mortality” AND Cardiovascular events” were searched. A total of 7randomized controlled trials out of 5,051articles from PubMed and 117 articles from EMBASE were included in this systematic review. The primary outcome measures used in the included seven studies were HRQOL, restenosis, cardiac event, cardiac related mortality. Similar demographic and clinical characteristics of the subjects between the intervention and the control groups were recorded. The studies were from five countries. The average age of the subjects in the seven studies was 61years, the average half of them have history of myocardial infarction. Though there were discrepancies among the results generated in the included studies, the potential benefits of exercise-based cardiac rehabilitation could be seen.
Results: Compared with the non-exercise-based cardiac rehabilitation, patients allocated to the exercise-based cardiac rehabilitation program had greater improvement in HRQOL and reduction of cardiac events. The result of reducing restenosis was inconsistent. The cardiac related mortality is not significant difference between exercise-based and non-exercise-based cardiac rehabilitation.published_or_final_version
Public Health
Master
Master of Public Health
28
裴中 and Zhong Pei. "Neuroprotection of melatonin in ischemic stroke models." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B31243526.
29
Yao, Guiqing. "The economic evaluations of interventions for heart diseases." Thesis, University of Birmingham, 2010. http://etheses.bham.ac.uk//id/eprint/1058/.
Abstract:
The primary aim of the thesis was to report new cost-effectiveness evidence in the clinical area of heart disease. Following a review of published empirical work, this was achieved by undertaking three new cost-effectiveness studies: one in nurse-led secondary prevention clinics for coronary heart disease in primary care, one on cardiac resynchronisation therapy with or without an implantable cardioverter defibrillator in chronic heart failure, and the final one on a new drug therapy, nebivolol, compared with standard treatment in elderly patients with heart failure. The second aim of the thesis concerned the application of modelling methodology, with the intent being the provision of general recommendations in using Markov modelling approaches in economic evaluation conducted in the heart disease area. The focus was on extrapolation of cost-effectiveness of an intervention beyond a trial both in terms of the time horizon of the analysis and in relation to the population involved. Fundamental issues in parametric distribution functions and Markov modelling approaches have been revisited, with detailed consideration of which parametric distribution functions should be employed when extrapolating beyond a trial and how they could be adopted into model-based analyses. The need for further methodology investigations in this area is discussed in conclusion.
30
Veroni, Margherita. "The use of pharmacotherapies in the secondary prevention of coronary heart disease." University of Western Australia. School of Population Health, 2006. http://theses.library.uwa.edu.au/adt-WU2006.0029.
Abstract:
[Truncated abstract] Background: This thesis examines pharmacotherapy use in the secondary prevention of coronary heart disease. It includes antiplatelet agents, beta-blockers, statins and ACE inhibitors, all shown in landmark clinical trials and meta-analyses to reduce the risk of cardiac events in patients with known coronary disease. Underuse of effective preventive therapies represents a lost opportunity to reduce mortality and morbidity. Overseas studies have shown significant underuse of effective therapies at the time of hospital discharge following an acute event and later in ambulatory care. Australian data on prescribing practices following an acute coronary event and, ongoing use in ambulatory care are sparse. Aims: The aim of this thesis was to quantify the prescription of known effective therapies at the time of hospital discharge following an acute coronary event and ongoing use in ambulatory care. A secondary aim was to identify barriers to optimal secondary prevention thus providing an evidential basis to recommend change. Methods: This was an observational study of a cohort of post-MI patients admitted to a tertiary and affiliate hospital in Perth, Western Australia. The continuum of care from the treatment plan at discharge through to the treatment regimen and risk factor management 12 months post-MI was examined. The intermediate step, communication about the treatment plan with the patient and the primary health care provider was also examined. The study involved a review of hospital medical records and follow-up questionnaires to patients and their general practitioners at 3 and 12 months post-MI. All post-myocardial patients were included in the analysis of prescriptions at discharge. The follow-up study included patients 80 years and younger with no terminal conditions. Patient interviews at 3 months and interviews and focus groups with key hospital staff provided qualitative data to inform the quantitative data.
31
Ashton, Emma Louise, and emma ashton@deakin edu au. "Effects of dietary constituents on coronary heart disease risk factors." Deakin University. School of Biological and Chemical Sciences, 2000. http://tux.lib.deakin.edu.au./adt-VDU/public/adt-VDU20061207.153511.
Abstract:
Coronary Heart Disease (CHD) is a major cause of death in Western countries. Mediterranean and Asian populations have a lower risk of death from CHD compared to Westernised population, as do vegetarian versus omnivorous populations. Dietary constituents of traditional diets consumed by these populations are thought to influence both the classical risk factors for CHD, and the more recently identified risk factors, such as oxidative modification of low density lipoprotein (LDL), LDL particle size, arterial compliance and haemostatic factors. The aim of this thesis was to examine the effects of several food components, particularly soybean and monounsaturated fat (MUFA), on CHD risk factors through 3 carefully controlled dietary interventions, and a cross-sectional study.
A randomised crossover dietary intervention study was conducted in 42 healthy males to investigate the effect on CHD risk factors of replacing lean meat with tofu, a soybean product regularly consumed by Asian populations, while controlling all other dietary factors. The tofu diet resulted in significantly lower total cholesterol and triacylglycerol levels compared to the lean meat diet, and LDL particles that were more resistant to in vitro oxidative modification. However, insulin, fibrinogen, factor VII, and lipoprotein (a) were not significantly different on the 2 diets.
A postprandial study was subsequently conducted to investigate any acute effects of a tofu test meal on the oxidative modification of LDL in 16 male subjects. There was no significant difference between the susceptibility of LDL to oxidative modification before and after the tofu meal.
Twenty eight healthy subjects completed a separate randomised crossover dietary intervention comparing a high MUFA fat diet, using an Australian high oleic sunflower oil, with a low fat, high carbohydrate diet on CHD risk factors. The high MUFA oil diet significantly increased high density lipoprotein cholesterol compared to the low fat diet as well as producing LDL that were more resistant to oxidative modification. Neither the size of the LDL particle nor arterial compliance were significantly different on the 2 diets.
Twelve matched pairs of vegetations and omnivores were also studies to compare the habitual diet of a low and higher risk population group, to compare their risk factors and identify dietary constituents that may explain the differences. The vegetarians consumed less saturated fat (SFA) and dietary cholesterol while consuming more polyunsaturated fat, dietary fibre and vitamin E compared to omnivores. The vegetarians had lower total cholesterol, LDL cholesterol and triacylglycerol levels compared to the omnivores and had LDL particles that were more resistant to in vitro oxidation.
These findings contribute to our knowledge about the dietary constituents that can alter some CHD risk factors in healthy subjects, and which could reduce the risk of developing CHD. Investigations in high risk groups might reveal even more benefits.
32
Lalonde, Lyne. "Health-related quality of life measures in coronary heart disease prevention and treatment." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0006/NQ44484.pdf.
33
Khatib, R. "Adherence to secondary prevention medicines by coronary heart disease patients : first reported adherence." Thesis, University of Bradford, 2012. http://hdl.handle.net/10454/5484.
Abstract:
Background Non-adherence to evidence based secondary prevention medicines (SPM) by coronary heart disease (CHD) patients limits their expected benefits and may result in a lack of improvement or significant deterioration in health. This study explored self-reported non-adherence to SPM, barriers to adherence, and the perception that patients in West Yorkshire have about their medicines in order to inform practice and improve adherence. Methods In this cross-sectional study a specially designed postal survey (The Heart Medicines Survey) assessed medicines-taking behaviour using the Morisky Medicines Adherence 8 items Scale (MMAS-8), a modified version of the Single Question Scale (SQ), the Adherence Estimator (AE), Beliefs about Medicines Questionnaire(BMQ) and additional questions to explore practical barriers to adherence. Patients were also asked to make any additional comments about their medicines-taking experience. A purposive sample of 696 patients with long established CHD and who were on SPM for at least 3 months was surveyed. Ethical approval was granted by the local ethics committee. Results 503 (72%) patients participated in the survey. 52%, 34% and 11% of patients were prescribed at least four, three and two SPMs respectively. The level of non-adherence to collective SPM was 44%. The AE predicted that 39% of those had an element of intentional non-adherence. The contribution of aspirin, statins, clopidogrel, beta blockers, angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs) to overall non-adherence as identified by the SQ scale was 62%, 67%, 7%, 30%, 22% and 5%, respectively. A logistic regression model for overall non-adherence revealed that older age and female gender were associated with less non-adherence (OR = 0.96, 95% CI: 0.94, 0.98; OR = 0.56, 95% CI: 0.34, 0.93; respectively). Specific concern about SPM, having issues with repeat prescriptions and aspirin were associated with more non-adherence (OR = 1.12, 95% CI: 1.07, 1.18; OR = 2.48, 95% CI: 1.26, 4.90, OR = 2.22, 95% CI: 1.18, 4.17). Other variables were associated with intentional and non-intentional non-adherence. 221 (44%) patients elaborated on their medicines-taking behaviour by providing additional comments about the need for patient tailored information and better structured medicines reviews. Conclusions The Medicines Heart Survey was successful in revealing the prevalence of self-reported non-adherence and barriers to adherence in our population. Healthcare professionals should examine specific modifiable barriers to adherence in their population before developing interventions to improve adherence. Conducting frequent structured medicines-reviews, which explore and address patients' concerns about their medicines and healthcare services, and enable them to make suggestions, will better inform practice and may improve adherence.
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Sotero, Charity Faith Gallemit. "Statistical Support Algorithms for Clinical Decisions and Prevention of Genetic-related Heart Disease." Thesis, California State University, Long Beach, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10751893.
Abstract:
Drug-induced long QT syndrome (diLQTS) can lead to seemingly healthy patients experiencing cardiac arrest, specifically Torsades de Pointes (TdP), which may lead to death. Clinical decision support systems (CDSS) assist better prescribing of drugs, in part by issuing alerts that warn of the drug’s potential harm. LQTS may be either genetic or acquired. Thirteen distinct genetic mutations have already been identified for hereditary LQTS. Since hereditary and acquired LQTS both share similar clinical symptoms, it is reasonable to assume that they both have some sort of genetic component. The goal of this study is to identify genetic risk markers for diLQTS and TdP. These markers will be used to develop a statistical DSS for clinical applications and prevention of genetic-related heart disease. We will use data from a genome-wide associate study conducted by the Pharmacogenomics of Arrhythmia Therapy subgroup of the Pharmacogenetics Research Network, focused on subjects with a history of diLQTS or TdP after taking medication. The data was made available for general research use by National Center for Biotechnology Information (NCBI). The data consists of 831 total patients, with 172 diLQTS and TdP case patients. Out of 620,901 initial markers, variable screening is done by a preliminary t-test (α=0.01), and the resulting feasible set of 5,754 markers associated with diLQTS to prevent TdP were used to create an appropriate predictive model. Methods used to create a predictive model were ensemble logistic regression, elastic net, random forests, artificial neural networks, and linear discriminant analysis. Of these methods using all 5,754 markers, accuracy ranged from 76.84% to 90.29%, with artificial neural networks as the most accurate model. Finally, variable importance algorithms were applied to extract a feasible set of markers from the ensemble logistic regression, elastic net, and random forests methods, and used to produce a subset of genetic markers suitable to build a proposed DSS. Of the methods using a subset of 61 markers, accuracy ranged from 76.59% to 87.00%, with ensemble logistic regression as the most accurate model. Of the methods using a subset of 22 markers, accuracy ranged from 74.24% to 82.87%, with the single hidden layer neural network (using the subset of markers extracted from the ensemble bagged logistic model) as the most accurate model.
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Saguilig, Lauren G. "A Clinical Decision Support System for the Prevention of Genetic-Related Heart Disease." Thesis, California State University, Long Beach, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10264716.
Abstract:
Drug-induced long QT syndrome (diLQTS) is a common adverse drug reaction characterized by rapid and erratic heart beats that may instigate fainting or seizures. The onset of diLQTS can lead to torsades de points (TdP), a specific form of abnormal heart rhythm that often leads to sudden cardiac arrest and death. This study aims to understand the genetic similarities between diLQTS and TdP to develop a clinical decision support system (CDSS) to aide physicians in the prevention of TdP. Highly accurate classification algorithms, including random forests, shrunken centroid, and diagonal linear discriminant analysis are considered to build a prediction model for TdP. With a feasible set of markers, we accurately predict TdP classifications with an accuracy above 90%. The methodology used in this study can be extended to dealing with other biomedical high-dimensional data.
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Boobier, Wyndham J. "The development of a functional food to reduce selected risk factors associated with coronary heart disease." Thesis, University of South Wales, 2003. https://pure.southwales.ac.uk/en/studentthesis/the-development-of-a-functional-food-to-reduce-selected-risk-factors-associated-with-coronary-heart-disease(0c4a2022-9af5-4b7c-bc44-73f00c90d27e).html.
Abstract:
Coronary heart disease (CHD) remains one of this country's leading cause of mortality. This study has concentrated on the development of a functional biscuit, which will reduce selected risk factors for heart disease, in particular elevated serum homocysteine. The developed biscuit contains vitamins Be, Bi 2, and folic acid, all of which have been shown to be important in homocysteine metabolism. There were a number of criteria that had to be met for the author to receive the full support of Burton's Foods: (1) The biscuit must remain commercially viable and be accepted by the consumer. (2) Enzymes should not be used in the preparation of the dough. (3) The jam could not be modified in any way. Without exception, these have been successfully achieved. Jammie Dodgers were selected as the control product for a number of reasons. They are one of the UK's best selling biscuits and are consumed by both children and adults. This makes the target number of consumers very large. In addition, the standard product is high in both fat and sugar, its modification into a health promoting biscuit was therefore technically challenging. The product resulting from this project is commercially viable; it is low in fat and sugar, contains the vitamins that will deliver the full RNI on consumption of just two biscuits daily, and is not significantly different to the control product. The product is also palatable. Clinical trials have demonstrated that following consumption of the product, serum homocysteine, an independent risk factor for coronary heart disease, has been significantly reduced. In addition, there appears to be a relationship with consumption of the modified biscuit and a fall in serum lipoprotein(a). It is possible to reduce selected mutable risk factors associated with heart disease, simply by the daily consumption of a product that is liked and consumed by a great number of people. As far as the author is aware, there has been no other development of this kind prior to this study, i.e. a biscuit that will reduce the risk of coronary heart disease by lowering serum homocysteine. This biscuit is therefore the first of its kind.
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Vedin, Ola. "Prevalence and Prognostic Impact of Periodontal Disease and Conventional Risk Factors in Patients with Stable Coronary Heart Disease." Doctoral thesis, Uppsala universitet, Institutionen för medicinska vetenskaper, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-260564.
Abstract:
The purpose of this thesis was to assess the prevalence and management of established cardiovascular (CV) risk factors and the prevalence and influence of self-reported markers (number of teeth and frequency of gum bleeding) of periodontal disease (PD), a less explored CV risk factor, in patients with stable chronic coronary heart disease (CHD). We studied patients from the global STabilization of Atherosclerotic plaque By Initiation of darapLadIb TherapY (STABILITY) trial (n=15,828), in which patients with stable chronic CHD were randomized to either darapladib or placebo. Our studies were performed using descriptive statistics and multivariable linear, logistic and Cox regression models. The use of secondary preventive medications was generally high across the whole study population. Despite this, CV risk factors were highly prevalent, including obesity, hypertension and hypercholesterolemia. Achievement of guideline-recommended treatment targets was lacking and little improvement was seen throughout the study duration. Approximately 40% of patients reported having <15 remaining teeth and 25% reported gum bleeding. More tooth loss was associated with a greater CV risk factor burden after adjustment, while the associations for gum bleeding were less evident. After multivariable adjustment for CV risk factors and socioeconomic status, more tooth loss was associated with an increased risk of major adverse CV events (a composite of CV death, myocardial infarction and stroke), CV mortality, all-cause mortality and fatal or non-fatal stroke. We found associations between a higher degree of tooth loss and elevated levels of several prognostic biomarkers known to reflect various pathophysiological mechanisms involved in CV morbidity and mortality. Most biomarkers had little attenuating effect on the relationship between tooth loss and outcomes in a multivariable model. In conclusion, we found an inadequate CV risk factor control despite a high use of evidence-based pharmacological therapies, likely to explain some of the excess risk in CHD patients. Further, we demonstrated a high prevalence of PD markers, tooth loss in particular, that were associated with a wide range of established CV risk factors, prognostic biomarkers and outcomes. Collectively, these findings indicate that tooth loss may be a significant risk factor among patients with stable chronic CHD.
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Will, Catherine M. "Medical reason : clinical science and preventing coronary heart disease 1984-2004." Thesis, University of Essex, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.421151.
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Carcaise-Edinboro, Patricia. "Factors Associated With the Provision of Coronary Heart Disease Preventive CareServices." VCU Scholars Compass, 2006. https://scholarscompass.vcu.edu/etd/762.
Abstract:
The Anderson and Aday access framework (1974) is utilized to investigate the association of individual and community level, predisposing, socio-demographic, and enabling factors, on potential and realized access to coronary heart disease (CHD) preventive care. The cross-sectional study is based on a sample of adults age 18-85 from the Medical Expenditure Panel Survey (MEPS) who were identified with CHD risk or who had a CHD diagnosis.Variables from the MEPS and the Area Resource File (ARF) are used to test logistic regression models for dependent variables measuring primary and secondary CHD preventive care services. The primary preventive care measures include blood cholesterol testing, blood pressure checks, and, diet, exercise and smoking cessation counseling. The secondary preventive measures include beta-blocker reciept after myocardial infarction (MI) and statin drug use for the treatment of high blood cholesterol.Being uninsured is associated with a reduced likelihood of receiving primary CHD preventive care. Overall study results indicated gender and race are more consistent predictors of the receipt of CHD preventive care services than individual enabling or community characteristics. Women had a greater likelihood of receiving primaryCHD preventive care services than men. Hispanics are less likely than Caucasians to receive primary CHD preventive care services, except for blood cholesterol testing for which they are more likely to receive. Blacks are more likely than Caucasians to have blood cholesterol testing, but are no less likely to receive the other primary CHD preventive care measures. Blacks demonstrate a lower likelihood of receiving secondary CHD preventive care than Caucasians, specifically beta-blocker post myocardial infarction indicating that disparities in secondary CHD preventive care persist for segments of the study population. Persons over 75 years of age are less likely to receive primary CHD preventive care services as well as the secondary preventive measure ofstatin use for high blood cholesterol.Community level factors did not improve the logistic regression model for the receipt of CHD preventive care, yet, when predicting potential access for preventive services, persons from a higher percent Hispanic or black community were less likely to have a usual source of care.
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Watts, Eric J. "Coagulation changes in long distance runners and their relevance to the prevention of ischaemic heart disease." Thesis, University of Southampton, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.328774.
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Moreno, Gabriel Mario. "The Effects of Coaching Strategies for Primary Prevention of Coronary Heart Disease Involving Asymptomatic Hospital Employees." Wright State University / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=wright1240238745.
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周娉瑤 and Ping-yiu Chow. "Antibiotic prophylaxis for the prevention of infective endocarditis incongenital heart disease: knowledge ofparents and dentists." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43250907.
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Heriot, Jody L. "Implementation of a Beta Blocker Protocol." UNF Digital Commons, 2012. http://digitalcommons.unf.edu/etd/415.
Abstract:
Background: Beta blockers are recommended by the American College of Cardiology/American Heart Association Guidelines for high and intermediate-risk cardiac patients undergoing non-cardiac surgery. Beta blockers are a class of drugs that moderate the effects of increased catecholamine levels on the heart by selectively blocking beta receptors in the heart and blood vessels, resulting in a lower heart rate and blood pressure. Beta blocker use perioperatively has been shown to reduce the risk of ischemia and infarction.
Purpose: The purpose of this project is to address beta blocker use in a group of anesthesia providers who routinely attend to high-risk and intermediate-risk cardiac patients undergoing non-cardiac surgery in a medium-sized private hospital in suburban South Florida. There are barriers to the implementation of the published guidelines for beta blocker administration, including lack of awareness of the best current practice and a lack of a formal beta blocker protocol at the institutional level.
Methods: A simple and inexpensive beta blocker protocol was implemented and evaluated by various means. Beta blocker administration practices were examined and documented prior to and after protocol implementation. Beta blocker usage was examined prior to and after protocol implementation
Findings/Implications: It was hypothesized that increased anesthesia provider awareness would lead to increased administration of perioperative beta blockers to high-risk and intermediate-risk cardiac patients undergoing non-cardiac procedures. Although there was a knowledge increase related to the new beta blocker protocol, no change in practice was observed.
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McAnlis, Gareth Thomas. "Dietary flavonoids and their possible role as antioxidants in preventing atherosclerosis." Thesis, Queen's University Belfast, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.268230.
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Stokes, Helen Clare. "A study of the evolution of cardiac rehabilitation in the United Kingdom, from the 1940s to the 1990s." Thesis, University of Hull, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.327183.
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Chow, Ping-yiu. "Antibiotic prophylaxis for the prevention of infective endocarditis in congenital heart disease knowledge of parents and dentists /." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B43250907.
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Alhamarneh, Y. N. "Coronary Heart Disease-Public Knowledge and The Pharmacist's Patient-Centred Role in Prevention and Management." Thesis, Queen's University Belfast, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.527655.
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Chinwong, Surarong. "Pharmaceutical care in coronary heart disease prevention : study to measure and influence quality of prescribing." Thesis, University of Strathclyde, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.400332.
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Brito, Ema C. "Gene x lifestyle interactions in type 2 diabetes mellitus and related traits." Doctoral thesis, Umeå : Umeå University, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-30523.
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Campbell, N. C. "Secondary prevention in coronary heart disease : a randomised trial of nurse-led clinics in primary care." Thesis, University of Cambridge, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.597263.