A STUDY TO ASSESS THE EFFECTIVENESS OF INFORMTION …



A STUDY TO ASSESS THE EFFECTIVENESS OF INFORMTION LEAFLET ON NATURAL-LIPID LOWERING AGENT AMONG CAD PATIENTS IN SELECTED HOSPITALS AT BANGALORE.

M.Sc. Nursing Dissertation Protocol submitted to

[pic]

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

By

MR. SUBIN SEBASTIAN

M.Sc NURSING 1ST YEAR

2012-2014

Under the Guidance of

MR.SIDDAPPA

HOD, Department of Medical Surgical Nursing

K.T.G College of Nursing

Gandhadakaval,

Hegganahalli Cross

Vishwaneedam Post

Bangalore-91

REGISTRATION OF SUBJECTS FOR DISSERTATION

| | | |

|1 |NAME OF THE CANDIDATE |MR.SUBIN SEBASTIAN |

| | | |

|2 |NAME OF THE INSTITUTE |K.T.G COLLEGE OF NURSING |

| | | |

|3 |COURSE OF THE STUDY AND SUBJECT |M.Sc NURSING I YEAR |

| | |MEDICAL SURGICAL NURSING |

| | | |

|4 |DATE OF ADMISSION | |

| | | |

| | |“A STUDY TO ASSESS THE EFFECTIVENESS OF INFORMATION LEAFLET ON |

|5 |TITLE OF STUDY |NATURAL-LIPID LOWERING AGENT AMONG CAD PATIENTS IN SELECTED HOSPITALS|

| | |AT BANGALORE.” |

6. BRIEF RESUME OF INTENDED WORK

INTRODUCTION

“I love those who can smile in trouble,

Who can gather strength from distress,

And grow brave by reflection.

It’s the business of little minds to shrink,

But they whose heart is firm,

And whose conscience approves their conduct,

Will pursue their principles unto death.

Leonardo ad Vinci

“Health is wealth and is a basic human right”. Good health is always around the corner but never actually reached, but there is always something more to be achieved. In this view health is a goal in itself, the end instead of one of the means of fulfilling life’s purposes. During the past 50 years the health problems of people have changed significantly. Although many of the diseases have been controlled or eradicated, majority of the health problems seen today are chronic in nature and nowadays increasing emphasis is given to the cardiovascular disorders.1

Coronary artery disease is the most common type of cardiovascular disease and accounts for the majority of these deaths. Patients with CAD can be asymptomatic or develop chronic stable angina. It is characterized by a focal deposit of cholesterol and lipids, primarily within the intimal wall of the artery. The genesis of plaque formation is the result of complex interactions between the components of the blood and the elements forming the vascular wall.2

Coronary Artery Disease is the single largest killer of both men and women in the United States, with nearly 2500 deaths per day. Although these numbers seem high, the death rate from CAD decreases by 30% from 1993 to 2003.Children whose parents had heart disease is at higher risk for CAD. This increases risk is related to genetic predisposition to hypertension, elevated lipid levels, diabetes and obesity, all of which increase the risk of CAD3

India is facing an epidemiological transition for prevalence of CAD. CAD prevalence in urban population increases from 3.5% in 1960s to 10.5% in1990s and the corresponding change for the rural population was from 2% to 4%. The rates appear to be highest in South India. It has been estimated that India had the highest number of deaths in the world due to CAD in 2002-nearly 1.5 million and which is expected to double by 20154.

The risk of CAD increases as blood cholesterol levels increase. In adults total cholesterol levels of 240mg/dl are classified as “high” and levels ranging from 200mg/dl to 239mg/dl are classified as “borderline high”. At young and middle ages, men have higher cholesterol levels, in women cholesterol levels continue to increase up to about age705.

Clinical high cholesterol is usually found in the blood values on an annual check-up. No signs or symptoms may be present even with life threatening atherosclerotic disease. This diagnosis may be a result of a life of poor eating habits, sedentary lifestyle, smoking, excessive drinking, etc. You may be experiencing angina, hypertension, or kidney disease as well as the elevated blood lipids. Even though it's quite likely you can control your high cholesterol with some basic dietary changes, there are some other disease problems which can cause this syndrome.6

Herbs and other natural products have been around alot longer than the standard prescription drugs used today to control high cholesterol. They are usually derived from plants, trees, and other sources. Unfortunately, herbal drugs are not regulated by the Food and Drug Administration, so you have to be careful about what other chemicals are in the pills you are taking besides the herb that you want to take. This is especially true of herbal drugs manufactured in foreign countries, which will actually put a prescription drug, like a satin drug, into the pill with the herb without listing it in the ingredients section. So, be careful, and consult your health care practitioner before you start any type of herbal drug, because it might interfere with other medications you are taking7.

There are many natural products that can be used as an alternative to treating high cholesterol. This may be especially optimal to patients who are regulating their cholesterol levels with diet and exercise. Natural products reduce cholesterol levels by dissolving fat in the blood. Although much research has gone into evaluating which natural products are more helpful in reducing cholesterol levels, the exact mechanism by which it does this is not completely understood8

NEED FOR THE STUDY

The first clinical – trial evidence in support of the health benefits of the Mediterranean diet came from the Lyon Diet Heart Study, in which 605 clients with a previous MI were randomly assigned to Mediterranean diet or a control diet similar to the AHA step 1 Diet. Clients in the Mediterranean diet arm were encourage to eat more fruits, vegetables and fish; to eat less red meat; and to replace butter and cream with margarine high in alpha-linolenic acid. After a mean follow up of 27 months, the trial was stopped because of a 73% reduction in coronary events and a 70% reduction in all cause or total mortality in the Mediterranean diet arm of the study. 9

Sytrinol consists of citrus and palm fruit extract that contains polymethoxylated flavones (PMFs) and tocotrienols. Multiple studies show Sytrinol decreases total cholesterol by 30 per cent, low-density lipoprotein (LDL), the bad cholesterol, by 27 per cent and triglycerides by 34 per cent. In addition, high-density lipoprotein (HDL), the good cholesterol increases four per cent.10

The best approach to prevention of high cholesterol is regular aerobic exercise and a low animal-fat diet. There are also specific nutritional approaches which include eating a low sugar diet (because where there's sugar, there's often fat too), with a high fiber content and, of course, low or no extra cholesterol and a low Sodium or Sodium-restricted diet. To get to the point of prevention, in other words to bring down you high cholesterol at the beginning of your therapy, try 2 or 3 weeks of a vegetarian cleansing diet or a series of short juice-only fasts . Do not attempt a fast unsupervised. Work with a doctor or an experienced friend.11

Foods that have specific ability to dissolve blood fats and therefore can help reduce high cholesterol include:

• garlic, wheat germ, liquid chlorophyll, alfalfa sprouts, buckwheat, watercress, rice polishings, apple, celery, cherries

• foods high in water-soluble fiber: flax seed, pectin, guar gum, oat bran

• onions, beans, legumes, soy, ginger, alf 12

According to some studies, garlic may decrease blood levels of total cholesterol by a few percentage points. Other studies, however, suggest that it may not be as beneficial as once thought. It may also have significant side effects and/or interaction with certain medications. Garlic may prolong bleeding and blood clotting time, so garlic and garlic supplements should not be taken prior to surgery or with blood-thinning drugs such as Coumadin.13

Red yeast rice has been found to lower cholesterol in studies and was previously found in the over-the-counter supplement Cholestin. However, in 2001, FDA took Cholestin off the shelf because it contained lovastatin, a compound found in the cholesterol prescription medication Mevacor. Reformulated "Cholestin" no longer contains red yeast rice. Other red yeast rice-containing supplements currently available in the U.S. contain very small amounts of lovastatin. Their effectiveness is questionable.14

Guggulipid is the gum resin of the mukul myrrh tree. In clinical studies performed in India, guggulipid significantly reduced blood levels of total cholesterol and LDL cholesterol. The enthusiasm for using guggulipid as a cholesterol-lowering herbal agent, however, diminished after the publication of negative results from a clinical trial in the U.S. Further research is necessary to determine the safety and efficacy of this herbs.15

REVIEW OF LITERATURE

The literature was reviewed and is presented under the following headings.

1. Study related to knowledge of natural lipid lowering agents among CAD patients

2. Study related to structured teaching programme regarding natural lipid lowering agents.

STUDIES RELATED TO KNOWLEDGE OF NATURAL LIPID LOWERING AGENTS AMONG CAD PATIENTS

Napoli C, Sica V. et al conducted a study on Station treatment and the natural history of atherosclerotic-related diseases: pathogenic mechanisms and the risk-benefit profile. Large-scale intervention trials demonstrate that treatment with statins, the most effective lipid lowering drug class, significantly reduces the risk of coronary heart disease events. Recent evidence suggests that more aggressive LDL cholesterol lowering with newly developed statins may provide greater clinical benefit, even in individuals with moderately elevated serum cholesterol levels. There is increasing evidence that statins exert a myriad of other beneficial pleiotropic effects on the vascular wall, thus altering the course of atherosclerotic disease. In the long-term treatment, non-life-threatening side effects may occur in up to 15% of patients receiving one statin. Significant elevations in the activity of serum aminotransferase and creatine kinase alone or in combination with muscle pain in statin-treated patients should be taken seriously. The combination of the statins with gemfibrozil results in higher rates of drug toxicity. Reports show possible adverse effects of statins on nervous system function including mood alterations; however, statins have also been associated with improvement in central nervous system disorders. Special attention must be paid to the tolerability of the statins in children, elderly and transplant patients. Future clinical studies and surveillance information will warrant long term safety of each member of this class of lipid-lowering agents. New classes of patients with diabetes, metabolic syndrome and renal diseases may have clinical benefits from statins. New upcoming clinical trials will address the fundamental question of whether statin treatment can protect from the natural history of atherosclerotic-related diseases. This will require a more prolonged follow-up (i.e., 10 to 15 years). Finally, the basic understanding of newer pathogenic mechanisms involving the effects of statins on angiogenesis and the nitric oxide pathway should be explored in the clinical setting as well as the study of pathogenic mechanisms by which statins can affect plaque instability.16

Gil-Nunez AC, Villanueva JA conducted a study on Advantages of lipid-lowering therapy in cerebral ischemia: role of HMG-CoA reeducate inhibitors. Dyslipemia as a risk factor for ischemic stroke and indications for statins in the prevention of ischemic stroke are revised. The role of cholesterol levels as a risk factor for ischemic stroke is controversial. This could be due to failures in the design of early epidemiological studies. Recent studies, however, do suggest a clearer risk relationship between cholesterol levels and ischemic stroke. Studies conducted on the prevention of ischemic heart disease (IHD) with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins), using pravastatin and simvastatin, unequivocally show reductions in overall mortality, cardiovascular mortality, acute myocardial infarction and other coronary events. These studies show a reduction in the risk of ischemic stroke, and although relative risk reduction is great, absolute risk reduction is low; the reasons for this are analyzed. Apart from lipid mechanisms, statins act on the atheroma plaque; they have antithrombotic and possibly neuroprotecting properties. Statins reduce the number of strokes due to the decrease of atherothrombotic strokes, cardioembolic strokes secondary to IHD, and lacunar strokes related to atherothrombosis and probably to microatheromas. Although there are currently no specific studies available on the secondary prevention of stroke with statins, which are required to clarify certain points, according to European and American guidelines for prevention, statins would be indicated in the secondary prevention of atherothrombotic stroke, and in cardioembolic and lacunar stroke associated with clinical or silent atherosclerosis (IHD, peripheral artery disease). Patients with ischemic stroke of other etiologies, except for stroke in the young or other unusual causes, are patients with a high vascular risk (cardiac and cerebral) owing to the stroke itself, age and other vascular risk factors, and they should also be treated with statins, at least from the point of view of primary prevention of IHD. Natural statins (pravastatin and simvastatin) play an essential part in secondary prevention of ischemic stroke, together with antiaggregants, anticoagulants, angiotensin-converting enzyme inhibitors and the treatment of other vascular risk factors.17.

Baller D, Gleichmann U conducted a study on Improved coronary vasodilator capacity by drug lipid lowering therapy in patients in the early stage of coronary atherosclerosis with reduced coronary reserves and moderate LDL hypercholesteremia An abnormal coronary flow reserve represents an early marker of impaired blood flow regulation in the natural history of coronary atherosclerosis under the impact of risk factors such as hypercholesterolemia. Our clinical investigation was aimed at assessing noninvasively the integrative coronary flow response to dipyridamole stress in 18 consecutive patients with microvascular angina, only moderately elevated LDL-cholesterol levels (168 +/- 33 mg/dl), and reduced vasodilator capacity despite normal (n = 9) or slightly abnormal (n = 9) coronary arteriograms (minimal disease with luminal irregularities and/or diameter reduction < or = 30%) before and after 6-month lipid-lowering therapy. An improvement of the non-invasively determined integrative dipyridamole induced coronary vasodilator capacity may be achieved after 6 months by intensive lipid lowering at a very early stage of coronary atherosclerosis. Consequently, aggressive cholesterol-lowering therapy represents an antiischemic and antianginal approach suggesting, at least in part, functional reversal and probably prevention of further disease progression.18

Turner BJ, conducted on A retrospective cohort study of the potency of lipid-lowering therapy and race-gender differences in LDL cholesterol control. They studied 3,484 older hypertensive patients with dyslipidemia in 6 primary care practices over a 4-year timeframe. Potency of lipid-lowering drugs calculated for each treated day and summed to assess total potency for at least 6 and up to 24 months. Cox models of time to LDL control within two years and logistic regression models of control within 6 months by race-gender adjust for: demographics, clinical, health care delivery, primary/specialty care, LDL measurement, and drug potency. The result of the study was Time to LDL control decreased as lipid-lowering drug potency increased (P < 0.001). Black women (N = 1,440) received the highest potency therapy (P < 0.001) yet were less likely to achieve LDL control than white men (N = 717) (fully adjusted hazard ratio [HR] 0.66 [95% CI 0.56-0.78]). Black men (N = 666) and white women (N = 661) also had lower adjusted HRs of LDL control (0.82 [95% CI 0.69, 0.98] and 0.75 [95% CI 0.64-0.88], respectively) than white men. Logistic regression models of LDL control by 6 months and other sensitivity models affirmed these results. Black women and, to a lesser extent, black men and white women were less likely to achieve LDL control than white men after accounting for lipid-lowering drug potency as well as diverse patient and provider factors. Future work should focus on the contributions of medication adherence and response to treatment to these clinically important differences.19

STUDIES RELATED TO INFORMATION LEAFLET ON NATURAL LIPID LOWERING AGENTS

Rashmi Kapoor A study was conducted on Among 40 randomly selected patients of Ludhiana the finding related that a structured teaching programme was effective in increasing the knowledge when compared with pre-test and post-test. A study was conducted on effectiveness of information leaflet on CAD patients’ reveals that mean score of subjects obtained for overall knowledge in pre-test was 59.09 and 89.6 in the post-test. The improvement mean score for overall knowledge was 30.2 with‘t’ value 18.8 which was statistically high significant at p ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download