Awareness on the coronary heart disease patient - a case series

Funding Acknowledgements Type of funding sources: None. Background Each year cardiovascular disease (CVD) causes 3.9 million deaths in Europe, accounting for 45% of all deaths. CVD are especially relevant not only due to the high mortality rate related to them, but also due to the disability associated with them. In Portugal, one of the specific skills of the medical-surgical nurse is to take care of the person and family / caregivers experiencing complex medical processes (such as acute coronary syndrome - ACS), resulting from chronic disease (such as coronary heart disease - CHD). The medium-range theory of transitions, by Meleis and collaborators, helps to frame the theoretical aspects in nursing practice. Nursing approaches to the person with CHD, are often focused on transmitting knowledge and teaching abilities, regardless of the perception the person may have of the need to pursue changes in his/her life. Purpose This study aimed at gathering information on how a person perceives, has knowledge, and recognises an acute coronary event as a moment of transition. It is intended to evaluate the level of awareness the person has of his/her situation in this health-illness transition, as to incorporate an approach based upon the transition’s theory. Methods The study was conducted on a Cardiology ward and Intensive Care Unit of a tertiary hospital in Northern Portugal, on the second half of September 2020. All patients admitted with an ACS were eligible. A qualitative research framework was adopted, using the semi-structured interview. When phrasing some questions, the phenomenological approach was adopted. Results Four patients were included. Their interviews showed a wide variability of knowledge about the motive for admission or what caused it; there was an uneven perception of the severity of the event; in general, they did not recognize the need to make changes in their lives or externalized the responsibilities for it. This study was limited by a reduced number of interviews conducted, limiting the generalization of the findings and conclusions, though it was not the purpose of this exercise. Also, the interviews were performed in different moments after admission, so some of the patients had already been approached by the nursing staff in moments of health education, which may lead to information bias. Conclusions The traditional health education approach based on teaching the patients a set number of items needed to achieve a healthier lifestyle after an ACS, seem to produce very variable effects on how the person recognizes, perceives, and knows about his/her condition. The transition theory framework may be useful to engage patients in the process and, considering the reduced length of stay in the hospital, it is necessary the transition of care to the community. Awareness is a central concept in the patient"s adaptive process and, therefore, a major theme for nursing practice. Considering the apparent scarcity of evidence about it, it reveals to be an area of future investment.

Development of a Diagnostic Questionnaire for Damp Phlegm Pattern and Blood Stasis Pattern in Coronary Heart Disease Patients (CHD-DPBSPQ)

Background. The aim was to develop a diagnostic questionnaire for damp phlegm pattern and blood stasis pattern in coronary heart disease patients (CHD-DPBSPQ). Methods. The standard procedures of questionnaire development were carried out to develop and assess CHD-DPBSPQ. The patients were assessed using the CHD-DPBSPQ, CHD-DPPQ, and CHD-BSPQ. Four methods were used to select the items on the CHD-DPBSPQ in a pilot study based on data from a Guizhou tertiary grade A hospital. Cronbach’s alpha and the split-half reliability, test-retest reliability, content validity, criterion validity, construct validity, and convergent validity were determined in a validation study using a nationwide sample. Results. After item selection, the CHD-DPBSPQ contained 15 items in two domains: the phlegm domain (9 items) and the blood stasis domain (6 items). For the CHD-DPBSPQ, the alpha coefficient was 0.88, the split-half coefficient was 0.90, and the intraclass correlation coefficient was 0.83. The range of the item-level content validity index (I-CVI) was 0.71 to 1.0 and that of the scale-level content validity index/average (Scale-CVI/Ave) was 0.97. The domain scores on the CHD-DPBSPQ were in close relation to the scores on a questionnaire for damp phlegm pattern in coronary heart disease patients (CHD-DPPQ) and a questionnaire for blood stasis pattern in coronary heart disease patient (CHD-BSPQ) (P<0.01). The root mean square error of approximation (RMSEA) was equal to 0.05 (90% CI: 0.044, 0.059). Convergent validity was demonstrated with a moderate correlation. Conclusion. The CHD-DPBSPQ is a reliable and valid instrument.

Profil Interaksi Verbal Pasien Penyakit Jantung Koroner dalam Berkomunikasi

Coronary heart patients are very strong subjects in the research of verbal interaction profiles. Because a lot of verbal interactions must be understood by patients as communicators. Simple communication theory to find this interaction has several elements, namely Communicator, Message (Message), Channel, Communicative, and Feed back. This type of research uses qualitative descriptive methods including observations in the location of the safira panjen Malang Main clinic, in-depth interviews with coronary heart patients who were included in the informant's criteria as a sample, namely Mr. Suryadi who had long been treated as a coronary heart disease patient, as the primary informant , and supporting informants namely the closest person and specialist doctor and then data analysis. The results of this study can be concluded 1.) the profile of verbal interaction of coronary heart patients in communicating has Determinism the use of verbalization generally has conditions directed to meet the desired goals of coronary heart patients (communicators) in expressing messages in the form of language, symbols, chennel in the form of senses and HP in communicating, Feed Back with communicants, this leads to healing, and verbal interactions of a coronary heart patient (communicator) experience repeated conditions with the assumption that using Indonesian or Javanese language kromo inggil, Channel, Feed back given by communicant in this is like; family environment, workplace and physician at the same time) in Communicating Coronary Jatung Patients who finally get the full understanding and comfort and discomfort to influence their health condition, 2.) Obstacles are also experienced in interacting which lead to Polarization, Evaluation of Stasis in Coronary Heart Patients, Stereotypes Between Patients with Coronary Hearts (Communicators) with their communicants.

THE DESCRIPTION OF RESILIENCE IN POST-ACUTE ATTACK PATIENT WITH CORONARY ARTERY DISEASE

Background: Coronary heart disease patients shall experience physical, psychological and social changes that will affect life. The psychological condition of outpatients that has been investigated include anxiety, depression and quality of life, all of these problems can be attributed to resilience.Objective: The purpose of this study was to determine the image of resilience of coronary heart disease patient following up the acute attack in outpatient ward.Methods: The research method used quantitative descriptive using CD-RISC instrument 25. Instrument had validity value r = 0.83, P <.0001 and reliability value of Cronbach’s α 0.89. The selection of sample with consecutive sampling and got sample number 50 people for 2 weeks. Data were analyzed based on the value of each respondent categorized using tertile to see the overall resilience picture, while for the five sub-variables measured using the mean and standard deviation.Result: The results showed that almost half of respondents had 70-75 resilience. The mean value of sub-variables if sorted from the lowest to the highest is trust and reinforcement (2.71±0.58); competence and resilience (2.88±0.53); relationships with others (2.92±0.48); self-control (3.04±0.62) and spiritual influence (3.33±0.45). These results are influenced by lack of self-efficacy, optimism and family support.Conclusion: The conclusions of the research resilience of patients are in the medium category, for the lowest sub-variable value is trust and strengthening, while the highest is the spiritual influence. So, it is advisable to provide education to improve management skills post-acute attacks and increase social support in the care of patients at home.

Study on Pulse-Signal Detection Methods Using Wavelet Transform and Hilbert Huang Transform

The practical wrist pulse of the healthy person and the coronary heart disease patient were analyzed by wavelet transform (WT) and hilbert huang transform ( HHT), and the characteristic information (percentage of energy density) of the pulse signal was discussed. The simulation results show that both WT and HHT are efficient ways in analyzing and processing pulse signal, and can draw main characteristic information from pulse signal. However the basis function is preselected in WT, it doesnt need to be preselected in HHT. In HHT the intrinsic mode function (IMF) is obtained by empirical mode decomposition (EMD), it can reflect the instantaneous frequency of pulse signal, and has the actual physical meaning. The resolving power of time and frequency in WT is restricted by Heisenberg uncertainty principle, and is restricted by each other. While the resolving power of time and frequency in HHT is adaptively changed according to signal intrinsic characteristics. The HHT is more adaptive than WT in analyzing pulse signal. The HHT can offer a new idea to diagnose cardiovascular disease by wrist pulse signal.

ITIH4: A New Potential Biomarker of “Toxin Syndrome” in Coronary Heart Disease Patient Identified with Proteomic Method

Objective. This trial aims to look for the protein biomarker of “toxin syndrome” of CHD patients.Methods. We have performed two trials in this paper. The first trial was a randomized controlled trial (RCT) of the plasma proteome in unstable angina (UA) patients by Maldi-Tof Mass. The second trial was a nested case-control study in 1503 stable CHD patients with one-year followup for acute cardiovascular events (ACEs).Results. In the RCT study, 12 protein spots were found to be the differential protein for the significant differences between the difference of before and after treatment in group A and group B; 2 of them (3207.37 Da and 4279.95 Da) was considered to be unique to “toxin syndrome” for being differential proteins of group B but not group A. These 2 spots were identified as Isoform 1 of Fibrinogen alpha chain precursor (FGA, 3207.37 Da) and Isoform 2 of inter-alpha-trypsin inhibitor heavy chain H4 (ITIH4, 4279.95 Da), respectively. In the nested case-control study, the result of Western blot demonstrated that protein expression of ITIH4 in the group with followup ACEs was significantly lower than the matched group without followup ACEs (P=0.027).Conclusion. ITIH4 might be a new potential biomarker of CHD “toxin syndrome” in TCM, indicating the potential role in early identifying high-risk CHD patients in stable period.