Saudi Cultural Missions Theses & Dissertations
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Item Restricted Instrumental Activities of Daily Living Among Patients with Heart Failure(Saudi Digital Library, 2023-12-24) Algashgari, Elham Yousef; Otte, Julie L; Jung, MiyeonHeart failure (HF) is a prevalent public health concern affecting 6.2 million Americans. HF is associated with decreased cognitive and physical functioning that may decrease patients' ability to perform instrumental activities of daily living (IADL). IADL are central to maintaining independent living, taking care of oneself, and having a satisfactory quality of life. Little is known about theory-based approaches to IADL in HF and about the facilitators and barriers to treatment fidelity of cognitive interventions, which limit the ability to identify factors amenable to intervention to improve IADL. Thus, a theoretical model was developed to identify explanatory variables influencing IADL in HF based on theoretical and empirical literature. The overall purpose of this dissertation was to establish a theoretical model for IADL and assess the treatment fidelity of supporting clinical trials. Specific aims included: (1) characterizing IADL performance in patients with HF, (2) testing the newly developed theoretical model to assess the relationship between the explanatory variables of age and gender, HF severity, depressive symptoms, physical and cognitive dysfunctions, and IADL performance; and (3) identify facilitators and barriers to treatment fidelity perceived by intervenors while delivering computerized cognitive interventions to patients with HF. The study findings provide knowledge about the level of IADL performance in HF and identify factors that could be targeted for intervention in future studies.13 0Item Restricted An exploration of the perceptions and experiences of adult heart failure patients utilizing telehealth monitoring in their homes: A Qualitative Systematic Review(Saudi Digital library, 2023-12-13) Alhazmi, Raneem Mohammed Ahmed; Whittingham, Katharine; Brindley, Allison; Gee, GarethAbstract Background Heart failure (HF) is a significant health issue since affected individuals endure a substantial load of symptoms and restrictions in their physical functioning, with implications on their mental and behavioural welfare. The implementation of a telemonitoring system promises to enhance the treatment of the disease by facilitating prompt medication adjustments, early identification of signs and symptoms indicating illness progression, and fostering the adoption of self-care practices. This qualitative systematic review examines the overall experiences of adult heart failure patients who used telemonitoring equipment inside their homes as a component of follow-up treatment and self-management. Objective To identify and explore the experiences and perceptions of adult HF using TM in their homes. Methods A qualitative systematic review was performed using the JBI framework, studies released between 2010 and 2022 and the search was implemented from three central databases that have been carefully searched (CINHAL full text, MEDLINE and PUBMED). Results Seven qualitative investigations, for a total of more than one hundred patients diagnosed with heart failure using telemonitoring tools. A total of forty-nine results were identified and eight categories derive. Four synthesised results were obtained: awareness and knowledge about their condition promote reassurance and self-empowerment, continuity in care facilitates adherence to habits and self-management, patients value in-person interactions with healthcare practitioners and perceive telemonitoring systems as lacking personalized touch, patients find value in the time efficiency and user-friendliness of telemonitoring systems, but technical and economic barriers often outweigh these benefits. Conclusion TM can enhance patients' disease awareness, knowledge, and self-care competence. Patients generally reported feeling reassured and empowered through daily self-monitoring, which helped establish their healthy routines. However, the qualitative evidence indicates that patients still highly value human connection and in-person support from healthcare professionals, seeing TM as an adjunct instead of serving as a substitute for in-person interactions44 0Item Restricted COPING STRATEGIES AND HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH HEART FAILURE(ProQuest, 2023-10-13) Alanazi, Mohammed; Wyatt, GwenHeart failure (HF) contributes to poor physical and emotional health-related Quality of Life (HRQoL) and poor health outcomes. Coping strategies have been identified as essential in enhancing HRQoL. This 3-manuscript dissertation focuses on the stressor of heart failure (HF) associated severity and its relationship with coping and health-related quality of life (HRQoL). This dissertation is comprised of 3 manuscripts (a) a scoping review of literature on coping strategies and HRQoL; (b) a quantitative study of the associations between the stressor (HF severity), influencing factors (demographics [age, sex, education, and income] and HF duration), coping strategies (problem-focused, active emotion-focused, and avoidant emotion-focused), and physical and emotional HRQoL outcomes; and (c) a multiple mediation study that examines the mediating role of coping strategies between the stressor of HF severity and physical and emotional HRQoL. In chapter 2, a literature review was conducted following the Arksey and O’Malley template. This scoping review was guided by the TSCM. Eligibility criteria involved patients with HF, reported on coping strategies and HRQoL, and published in English. In chapters 3 and 4, a cross-sectional survey design was used. A convenience sample of individuals with HF were recruited online using Researchmatch.org. Using PROCESS macro for SPSS, a multiple mediation model was applied to evaluate if one or more coping strategy types served as a mediator between HF severity and emotional and/or physical HRQoL. In chapter 2, thirty-five studies were included (4 RCTs, 27 cross-sectional, and 4 qualitative/mixed methods). Active emotional coping (e.g., acceptance) and problem-focused (e.g., seeking social support) coping strategies were linked with better HRQoL, while avoidant emotional coping (e.g., denial) was linked to worse HRQoL. In the presence of the stressor of HF severity, key factors that influenced the types of coping strategy included sex, age, social support, income, education, spiritual beliefs, and illness duration. However, the evidence on the effectiveness of the type of coping on HRQoL remains inadequate due to the majority of studies being cross-sectional. The results of chapter 3 showed that 108 participants completed the study with an age range of 20-81 years (37.03±11.77 years). Most participants were male (57.4%, n=62) and self-identified as Black or African American (60.2%, n=65). The mediation analysis results showed that active emotion-focused coping mediated the relationship between all three NYHA classifications (II, III, and IV) and emotional, but not physical HRQoL. Finally, chapter 4 showed a statistically significant indirect effect on the emotional HRQoL through only active emotion-focused coping (X1=0.74 [95% CI: 0.01 to 1.97]; X2=0.73 [95% CI: 0.01 to 1.91]), which suggests that active emotion-focused coping served as a mediator between HF severity (all three NYHA classifications) and emotional HRQoL. This dissertation contributes to the science by recommending a consistent definition of the three types of coping and a better understanding of the influence of age, sex, education, income, and HF duration on coping strategies. This dissertation found that problem-focused and active emotion-focused coping were linked with improved physical and emotional HRQoL. Factors such as older age, male, and having a low level of education and lower level of income were showed as significantly associated with using more avoidant emotion-focused coping strategies, which can direct interventional work. Finally, this dissertation advances science by demonstrating that active emotion-focused coping serves as a mediator, playing an important role in mediating the effects between HF severity and emotional HRQoL. This will help initiating new intervention directions for nursing research, broadening the scope of education to enhance symptom management and QoL through nursing programs, and providing empirical evidence for clinicians to smoothly integrate into their practice. These contributions are expected to advance the field of HF science and care.53 0Item Restricted Does Using Empagliflozin Reduce Hospitalization for Heart Failure and Angina in People With Diabetes? A Systematic Review(2023-05-02) Alrefaee, Manal Ibrahim; Khan, EhsanBackground Current statistics show that there are over 422 million people with diabetes around the world, and these numbers are in continuous increase (Lin et al 2020). The presence of type 2 diabetes mellitus increases the incidence of cardiovascular diseases (Leon & Thomas 2015). There is an increase trend towards using SGLT2 (Sodium Glucose Cotransporter 2) inhibitors, including empagliflozin, in the treatment of people with diabetes as the have shown beneficial effects in improving glucose control and cardiovascular events. Objectives To examine whether empagliflozin decreases hospitalizations for heart failure or unstable angina for people with type 2 diabetes mellitus (T2DM). Selection method The included studies compared using empagliflozin, 25 mg/10 mg, with placebo, no treatment. Only randomized controlled trials selected. Participants were people ≥18 years old with type 2 diabetes mellitus. Method The preferred method for conducting this systematic review was the Cochrane Handbook for Systematic Reviews (2022). The search for study was carried out through EMBASE database, PubMed, and Cochrane from 2014 to 2022. The search strategy was the PICO, (P) stands for Population, (I) Intervention, (C) Comparison, and (O) Outcome. The selected studies were assessed for quality using CASP (Critical Appraisal Skills Programme) tool. The risk of bias was also assessed using the Cochrane Risk of Bias tool (RoB2). The study search, the quality assessment and risk of bias examination all conducted by one author. Main results Four studies were retrieved for this systematic review. The studies compared using empagliflozin, 25 mg or 10 mg, with placebo, no treatment. Hospitalizations for heart failure were significantly lower in intervention groups, there is no significant difference in all-cause hospitalization, and the as no significant difference in hospitalization for unstable angina between the two groups. Conclusion Provided the notable control of diabetes status, using empagliflozin had an association with decreased hospitalization for heart failure and other cardiovascular diseases. A strong recommendation for using empagliflozin depending on the available data. The effects of empagliflozin on hospitalization for heart failure or unstable angina require more examination in the future.33 0