In the control context halou arrhythmia order 5mg norvasc with amex, where the moderate heat was the least preferable outcome heart attack youtube safe 5mg norvasc, it was (unsurprisingly) rated as painful hypertension 28 years old purchase generic norvasc on line. In the other context it was the best possible outcome blood pressure medication green capsule 10mg norvasc overnight delivery, and here the exact same moderately painful heat was actually rated as pleasant— because it meant the intensely painful heat had been avoided. This somewhat surprising change in perception—where pain becomes pleasant because it represents relief from something worse—highlights the importance of the meaning individuals ascribe to their pain, which can have decisive effects in pain treatment (Leknes et al. In the case of touch, knowing who or what is stroking your skin can make all the difference—try thinking about slugs the next time someone strokes your skin if you want an illustration of this point. In a recent study, a group of heterosexual males were told that they were about to receive sensual caresses on the leg by either a male experimenter or by an attractive female experimenter (Gazzola et al. Although it was always the female experimenter who performed the caress, the heterosexual males rated the otherwise pleasant sensual caresses as clearly unpleasant when they believed the male experimenter did it. Moreover, brain responses to the “male touch” in somatosensory Touch and Pain 288 cortex were reduced, exemplifying how top-down regulation of touch resembles top-down pain inhibition. Pain and pleasure not only share modulatory systems—another common attribute is that we don’t need to be on the receiving end of it ourselves in order to experience it. How did you feel when you read about Aron cutting through his own tissue, or “Thomas” destroying his own bones unknowingly It’s quite likely that some of your brain areas processing affective aspects of pain were active even though the nociceptors in your skin and deep tissue were not firing. Pain can be experienced vicariously, as can itch, pleasurable touch, and other sensations. Those who were most “empathetic” also showed the largest brain responses (Singer et al. A similar effect has been found for pleasurable touch: the posterior insula of participants watching videos of someone else’s arm being gently stroked shows the same activation as if they were receiving the touch themselves (Morrison, Bjornsdotter, & Olausson, 2011). Summary Sensory experiences connect us to the people around us, to the rest of the world, and to our own bodies. In this module, we have seen how being able to inhibit pain responses is central to our survival—and in cases like that of climber Aron Ralston, that ability can allow us to do extreme things. We have also seen how important the ability to feel pain is to our health—illustrated by young “Thomas,” who keeps injuring himself because he simply doesn’t notice pain. While “Thomas” has to learn to avoid harmful activities without the sensory input that normally guides us, G. Too little sensation or too much of it leads to no good, no matter how pleasant or unpleasant the sensation usually feels. As long as we have nervous systems that function normally, we are able to adjust the volume of the sensory signals and our behavioral reactions according to the context we’re in. When it comes to sensory signals like touch and pain, we are interpreters, not measuring instruments. The quest for understanding how our sensory–processing mechanisms can be modulated, psychologically and physiologically, promises to help researchers and clinicians find new ways to alleviate distress from chronic pain. Your friend has had an accident and there is a chance the injury might cause pain over a prolonged period. We have learned that touch and pain sensation in many aspects do not reflect “objectively” the outside world or the body state. Rather, these experiences are shaped by various top down influences, and they can even occur without any peripheral activation. Why do you think the brain interprets the incoming sensory information instead of giving a one-to-one readout the way a thermometer and other measuring instruments would Feelings of pain or touch are subjective—they have a particular quality that you perceive subjectively. Is it possible that modern scientists can objectively measure such subjective feelings Touch and Pain 291 Vocabulary A-fibers Fast-conducting sensory nerves with myelinated axons. A -fibers conduct touch signals from low-threshold mechanoreceptors with a velocity of 80 m/s and a diameter of 10 m; A -fibers have a diameter of 2. The third and fastest conducting A-fiber is the A, which conducts proprioceptive information with a velocity of 120 m/s and a diameter of 20 m. C-fibers C-fibers: Slow-conducting unmyelinated thin sensory afferents with a diameter of 1 m and a conduction velocity of approximately 1 m/s. C-pain fibers convey noxious, thermal, and heat signals; C-tactile fibers convey gentle touch, light stroking. Chronic pain Persistent or recurrent pain, beyond usual course of acute illness or injury; sometimes present without observable tissue damage or clear cause. C-pain or A -fibers C-pain fibers convey noxious, thermal, and heat signals C-tactile fibers C-tactile fibers convey gentle touch, light stroking Cutaneous senses the senses of the skin: tactile, thermal, pruritic (itchy), painful, and pleasant. Descending pain modulatory system A top-down pain-modulating system able to inhibit or facilitate pain. Endorphin An endogenous morphine-like peptide that binds to the opioid receptors in the brain and body; synthesized in the body’s nervous system. Exteroception the sense of the external world, of all stimulation originating from outside our own bodies. Visceral input such as heart rate, blood pressure, and digestive activity give rise to an experience of the body’s internal states and physiological reactions to external stimulation. This experience has been described as a representation of “the material me,” and it is hypothesized to be the foundation of subjective feelings, emotion, and self-awareness. Nociception the neural process of encoding noxious stimuli, the sensory input from nociceptors. Nociceptors High-threshold sensory receptors of the peripheral somatosensory nervous system that are capable of transducing and encoding noxious stimuli. Nociceptors send information about actual or impending tissue damage to the brain. Noxious stimulus A stimulus that is damaging or threatens damage to normal tissues. C-tactile afferents form a special pathway that distinguishes social touch from other types of touch by selectively firing in response to touch of social-affective relevance; thus sending affective information parallel to Touch and Pain 293 the discriminatory information from the A -fibers. Pain Defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage,” according to the International Association for the Study of Pain. Placebo effect Effects from a treatment that are not caused by the physical properties of a treatment but by the meaning ascribed to it. These effects reflect the brain’s own activation of modulatory systems, which is triggered by positive expectation or desire for a successful treatment. Placebo analgesia is the most well-studied placebo effect and has been shown to depend, to a large degree, on opioid mechanisms. Placebo analgesia can be reversed by the pharmacological blocking of opioid receptors. The word “placebo” is probably derived from the Latin word “placebit” (“it will please”). Sensitization Increased responsiveness of nociceptive neurons to their normal input and/or recruitment of a response to normally subthreshold inputs. Clinically, sensitization may only be inferred indirectly from phenomena such as hyperalgesia or allodynia. Sensitization can occur in the central nervous system (central sensitization) or in the periphery (peripheral sensitization). S ocial touch hypothesis Proposes that social touch is a distinct domain of touch. C-tactile afferents form a special pathway that distinguishes social touch from other types of touch by selectively firing in response to touch of social-affective relevance; thus sending affective information parallel to the discriminatory information from the A -fibers. In this way, the socially relevant touch stands out from the rest as having special positive emotional value and is processed further in affect-related brain areas such as the insula. Somatosensory cortex Consists of primary sensory cortex (S1) in the postcentral gyrus in the parietal lobes and secondary somatosensory cortex (S2), which is defined functionally and found in the upper bank of the lateral sulcus, called the parietal operculum. Somatosensory cortex also includes Touch and Pain 294 parts of the insular cortex. Somatotopically organized When the parts of the body that are represented in a particular brain region are organized topographically according to their physical location in the body (see homunculus illustration). Spinothalamic tract Runs through the spinal cord’s lateral column up to the thalamus.
In order to arrhythmia young purchase 5 mg norvasc otc decode the spo ken word ‘dig’ hypertension jnc 8 classification buy norvasc no prescription, you might imagine that the neural rep resentations for ‘ d ’ arrhythmia alcohol buy norvasc online pills, ‘ i ’ blood pressure blurry vision buy norvasc canada, and ‘ g ’ are decoded individually and sequentially, and combined to map onto a sound representation of the word ‘dig’. The result is that the word ‘dig’ is activated in the semantic/conceptual knowledge system. Unfortunately, this description makes perfect sense but it is not how the speech system actually works. In fact, there is little agreement in the field of speech perception regarding the basic ‘building blocks’ of speech: is an individual phoneme the small est unit of analysis for speech systems Regions in blue show a specific response but it must also decode ‘who’ information in order to to language-specific phonological structure. Regions in lilac respond know who is speaking and ‘when’ in order to under to stimuli with the phonetic cues and features of speech, whereas those in purple respond to intelligible speech. Regions in pink stand the temporal order of speech phonemes, syl respond to verbal short-term memory and articulatory representa lables, words, and sentences. This information must be decoded accurately regardless of the differences in human speech: whether we hear a high-pitched voice of a child or a low-pitched voice of information. In a recent review article, Scott (2005) a man, whether we are speaking very loudly or whis provides a summary of findings to date and pro pering, or whether we are speaking quickly or slowly. However, the functional mapping of cor not rely solely on the physical aspects of speech since tical auditory processing streams remains an ongoing they vary so widely both within and across speakers. Despite the intricacies of speech perceptual processes, they occur with little attention or apparent effort on our part. While scientists have long function, it may well be the case that the auditory studied language in the brain and investigations of system in humans differs sharply from those in non the physical properties of sound date back to the early human primates. Let’s begin our discussion of how 19th century, the specific study of how acoustic signals we decode human speech with a brief discussion of map onto meaning is relatively new. The spectrograph was also by analyzing and recoding speech into simpler sig developed by scientists at Bell Labs and was based on nals that contained far less information than natural some of the principles Dudley developed during the human speech. The spectrograph analyzed the signal that was, nonetheless, quite understandable, sound signals and produced a picture called a spectro providing evidence that the speech signal contained gram (Figure 7. Darker shadings indicate higher amplitude, mostly contained in the formants within each speech sound. In a spectrogram, frequency of the speech signal is presented on the y-axis and time on the x-axis. The shading of the speech signal represents a third dimen sion, intensity (or energy). Intensity is presented in two ways: across time (x-axis) and within frequency (y-axis). In this way, the amount of intensity or energy can be represented both as a function of time during a sentence and as a function of frequency band within a spoken syllable or word. No shading (white areas) in regions of the spectrogram along the x-axis indicates silence at those points in time. Similarly, darker ning with the sound ‘d’ will map onto a single phoneme /d/, the shading along the y-axis indicates more energy at that physical instantiations of the initial /d/ are quite different. You will note that each speech sound Carroll, 1999, originally from Liberman, 1970. The formants or cally quite different depending on the phonemes that harmonics differ by individual, based on the size of the occurred just before and after them. The spectrograph radically changed how ance implied that there were no simple sound tem speech perception was investigated and provided a plates in the brain that mapped in a one-for-one basis method for scientists to evaluate substructural elements to phoneme identities. Despite these complexities regarding how speech There were two important outcomes of early inves is decoded, spectrograms enabled speech scientists to tigations of speech using spectrograms: first, spec describe pictorially important features in phonemes, trograms of sentences showed that gaps or silences such as where in the speech articulation system they within sentences did not map onto word boundaries, are produced (place of articulation) and the duration but occurred within words in many cases; and second, of the onset of vocal cord vibration (voice onset time). First, gaps or silences in the speech stream do not pro An important outcome of early speech science was vide the speech decoding system with information the realization that the physical features in individual 4. An alternative view is that speech and language processes exploit brain systems in use in general cognition, i. These two opposing viewpoints are still the topic for distinctive features in classes of speech sounds. However, it is likely that the neural systems for decod ing speech have a combination of domain-specific and speech sounds or phonemes did not provide invariant domain-general processing. Recall that the work of Fourier and Ohm provided a basis for deconstruct ing complex sounds into simpler sinusoidal parts. What are the basic elements or units for decoding That is, if speech perception did not entail an analysis speech The early of the sum of the physical parts, and it clearly could findings of a lack of invariance in phonemes provide not because the physical parts vary widely for a sin evidence against the phoneme as the best unit of anal gle phoneme, then how was it performed One theory ysis for speech perception, although phonemes are was that the neural systems for speech decoding were clearly critical elements in speech perception. Speech specialized and not part of the general auditory sys contains multiple cues, however, and so it is perhaps tem. A strong view of this theory that ‘speech was spe not surprising that a simple one-to-one mapping of cial’ held that the special systems for speech decoding phonemes to words does not provide a full descrip occurred as early as the ear (Liberman et al. Recall that the leagues to develop the motor theory of speech perception auditory system is not a uni-directional system, but (for a review, see Liberman and Mattingly, 1985). This has complex feedback systems that extend all the way theory suggested that speech perception was tightly to the cochlea as well as parallel interactive systems coupled to speech production, specifically the motor across cortical regions within auditory cortex, across articulation processes or gestures used in producing the hemispheres, and extending to other sensory and speech. The syllable as a basic neural representations of these gestures were accessed unit of speech makes some intuitive sense because of in speech perception. Other theories for speech per the lack of invariance issue as well as the importance ception have been developed since the motor theory, of decoding syllabic stress when mapping sound and this work is ongoing in speech science, with the onto meaning. For example, the words ‘melody’ and underlying notion that the speech system must have a ‘melodic’ are very similar in terms of the sequence of the way to maintain a perceptual constancy across a wide phonemes. However, the syllabic stress differences in variety of physical features in phonemes and words. Early neuroimaging studies by Binder and colleagues (for a review, see Binder, 1997) investigated stimulus based differences in auditory cortex by comparing brain 4. A general finding was more widespread lapping cues, perhaps a better way to understand activation in superior temporal gyrus and the superior how speech is encoded is to investigate what is the temporal sulcus for words as compared to the tones or minimal information required to comprehend speech Although these results could be interpreted as this approach was taken by Shannon and colleagues representing speech-specific processing in those audi (Shannon et al. Therefore, different brain activation pat quency information but differing levels of temporal terns might reflect speech versus non-speech functional information. Listeners were able to decode continu areas, but might also reflect areas that differ in terms of ous speech with remarkable accuracy, indicating that decoding complex features in sounds. Shannon’s the presentation of many classes of sounds, including work provided evidence that the temporal envelope noise bursts, tones, words, pseudowords (pronounce of speech might carry more relevant information for able non-words, such as ‘hig’, and reversed speech its decoding than the fine-grained features found in (Binder et al. Nevertheless, the major findings were that Heschl’s gryus and there have been many studies of how speech and the planum temporale were activated similarly for other classes of sounds are decoded in the brain and all sound stimuli. This result supports the notion that we highlight some of these here for you in the follow sound is processed in a hierarchical fashion, with ing section. Speech sounds activated a larger region of audi acquired, there are complex interactions between tory cortex than the non-speech sounds, extending into heard language and spoken language which guide the posterior superior temporal gyrus and the superior the development of language. Interestingly, the activation did not proposed a model for language processing in the late differ for words, pseudowords, and reversed speech. Because there were no differences would serve to constrain the output when producing between the words, pseudowords, and reserved speech words. This model remains in use today, and while we conditions, Binder and colleagues concluded that these know more about dynamic brain processes now than regions likely do not reflect semantic processing of the during Wernicke’s time, the model has provided an word meaning, but reflect phonological processing of important theoretical framework for studying human the speech sounds. There are many active lines of investigation into the neural mechanisms and regions employed in decoding human speech and this work is ongoing. The investigation of brain areas involv ing inner speech provides an intriguing way in which to study our own consciousness. Early neuroimaging studies investigated brain activa While there are clearly complex interactions between tion for hearing versus producing speech. One impor brain areas for decoding speech and producing speech, tant finding that has been reproduced many times theorized in early motor theories of speech perception is that auditory cortex is activated during speech and realized in later brain studies, the exact nature of production tasks as well as during the perception of the integrative processes and neural territory that are speech (Figure 7. There is evidence from neuroimaging studies, as well as from lesion studies with patients with aphasia, that 4. The result of the stroke is a blockage of blood flow, which causes neuronal death and produces a lesion.
If autism causes a decreased connectivity pulse pressure 16 buy norvasc on line amex, as has been posed by a new theory (Just blood pressure medication kinds buy 10 mg norvasc with mastercard, Cherkassky arrhythmia guidelines 2014 buy norvasc 2.5 mg on-line, Keller & Minshew hypertension 9 code generic norvasc 10 mg fast delivery, 2004), this could result in a measurable effect during the task. Indeed they found three indications of underconnectivity; both groups showed activation in similar brain regions, but the autism group showed lower activation in the frontal and parietal regions, likely to relate to differences in structural connections. Also the genu and the splenium have been found to be reliably smaller in the autism group and this correlated with frontal-parietal activity in the autism group (Just et al. This could explain the symptoms related to autism as children with autism prefer to concentrate on objects and not on people (Hughes, 2007). Patients suffering from alien hand syndrome report that one of their hands performs involuntary movements, resulting in intermanual conflict. Dysfunction of the corpus callosum was therefore thought to be a prime suspect in this syndrome. It was found that not all patients with alien hand syndrome suffered from callosal dysfunction. Some cases were caused by tumours which did not involve the corpus callosum, mainly involving frontal lobe areas (Kim, Lee, Lee & Kim, 2010). This underlines how important dissociation of symptoms is in investigation of morphological differences. Also alien hand syndrome is very rare, with relatively a few cases that exists, making it a difficult case to study intensely. Hutchinson, Mathias and Banich (2008) have done a meta analytic review combining data from 13 studies. The areas connected by the splenium involve the parietal cortex, which supports functions as sustained and divided attention (Hutchinson et al. Bipolar Disorder and Borderline Personality Disorder Bipolar disorder is a mood disorder characterized by manic and depressive periods. It is thought that impaired information transfer plays a role in developing mood dysregulation in bipolar disorder and borderline personality disorder and could thus be caused by callosal dysfunction. Reductions in size of anterior and posterior callosal regions and a global thinning of the corpus callosum have been reported in patients with bipolar disorder (Walterfang et al. These results have been compared with first-degree relatives to restrict callosal abnormalities with the disorder, and indeed these relatives did not differ with controls (Walterfang et al. This lack of morphological evidence could be related to the duration of the disorder, as Walterfang et al. Summary the exact function or dysfunction of the corpus callosum in above (neuropsychiatric) disorders remains uncertain. The behavioural abnormalities seen in above mentioned disorders can be ascribed as being a primary effect of the corpus callosum, but can also be attributed to be a secondary effect of dysfunctional cortical regions. However, some of the above mentioned disorders do show evidence of callosal involvement, exhibiting signs of altered morphology, underconnectivity or hyperconnectivity which results in behavioural abnormalities as seen in these disorders. Callosal thinning by defective myelination or decreased fiber density alters interhemispheric communication, resulting in behavioural deficits corresponding with the cortical regions connected to the corpus callosum, that can manifest itself in pathology specific symptoms. Morphological alterations in anterior callosal regions affects frontal lobe function as seen in patients with autism, creating difficulties with face recognition. Significant morphological alterations in the corpus callosum can therefore inform us about function, and can consequentially be responsible for dysregulation of interhemispheric transfer, i. Although it is possible to live without this white matter structure, it is required for a functional integration of cognitive and sensory information from one cerebral hemisphere to another. Without this hemispheric communication behavioural abnormalities occur, mainly due to the lateralization of brain function, thought to be mediated by the corpus callosum. This lateralization allows for more cortical space, but requires integration of cortical areas in the opposing hemisphere to function properly in some situations. This is seen in patients with a sectioned corpus callosum and is also known as the disconnection syndrome; left and right become dissociated and performance of ipsilateral body parts becomes poor when involving lateralized functional processes, such as language or spatial navigation. Partial callosotomies or callosal lesions have provided information about the functional specificity of the callosal sub regions. The sub regions connect to different cortical regions, and vary in fiber size and density. They do not have clear anatomical landmarks or boundaries that separate them from each other and this complicates resolving the exact function of callosal segments. Most early studies involve gross callosal size, there was no identification of callosal sub regions. This is incorporated in recent studies, but remains difficult due to the not well defined sub regions. The corpus callosum is an important mediator of interhemispheric transfer, but how the corpus callosum intercedes this transfer is a topic of discussion. According to some the corpus callosum acts as dam preventing information from reaching the opposing hemisphere and thereby increasing lateralization. Better callosal connectivity would then account for a higher degree of lateralization due to its inhibitory qualities, and this is known as the inhibitory theory. The excitatory theory poses that the corpus callosum actively integrates information between hemispheres. When the connectivity between hemispheres is increased this would decrease lateralization due to the excitatory qualities of the corpus callosum. Both theories are backed up with evidence from a number of different studies, and can both account for the origin of lateralization when looking from an evolutionary perspective. Although, evidence from recent studies in healthy and aged individuals do tend to bend towards the inhibitory model. The most used method to measure connectivity is callosal size, yet there is a lot of conflicting information between individuals of different age and sex and studies, relating to subject groups and methods used. Also, callosal size has been associated with small diameter fiber density but not with large diameter fibers, which allow for a much faster transmission of signals and involve mainly sensory information. Clarke and Zaidel (1994) have attributed the lack of significant associations between callosal morphology and behavioural laterality or interhemispheric transfer to the unreliability of size as a measure of connectivity. They proposed that callosal size is only a reliable measure when it comes to higher-order associative functions, but not sensory functions (Clarke & Zaidel, 1994; Putnam et al. However, the corpus callosum is a complex body of information with distinct components that act separately, maybe there is more than just one method of hemispheric interaction (Bloom & Hynd, 2005). It could be that the corpus callosum does not purely have an excitatory or inhibitory function, but this may possibly be dependent on a subcortico-cortical network that balances hemispheric activation according to the task demands (Schulte & Muller-Oehring, 2010). Although new techniques have provided more insight into callosal morphology, still little is known about the specific role of the different callosal sub regions in integrating cognitive and sensory information interhemispherically. Schulte and Muller-Oehring (2010) have reviewed recent findings concerning callosal function in interhemispheric processing and suggest that the different callosal areas can exhibit a different function. They suggest a different function for separate callosal regions for local-global processing (anterior callosal integrity mediates inhibitory signals, whereas posterior callosal integrity mediates facilitation) (Muller-Oehring, Schulte, Raassi, Pfefferbaum & Sullivan, 2007; Muller-Oehring, Schulte, Fama, Pfefferbaum & Sullivan, 2009), as well as semantic competition. Another possibility to investigate callosal function is looking at alterations in morphology in disorders. However, when investigating neuropsychiatric disorders there are a number of factors that can influence the outcome of an investigation. Many of these disorders have comorbidities, which in some cases have been controlled for, that can complicate any associations that have been found. Also, a lot of variation is seen in patient groups, such as age, gender and type of symptoms. Some neuropsychiatric illnesses can have distinct symptoms in different individuals, this can again be attributed to different abnormalities in the corpus callosum. The stage of illness can also affect morphology as seen in the schizophrenia research, differences between first-onset schizophrenics were more pronounced compared to chronic patients, possibly due to the medical treatment. In conclusion it remains difficult to investigate the true function of the corpus callosum. Although its function as mediator of interhemispheric transfer is established, its role regarding recruitment of brain regions in the opposing hemisphere by means of excitatory or inhibitory signals still is a topic of debate. The examples that have been posed in this thesis comply with both theories, making them both likely candidates. However it seems likely that there is a possibility of both inhibitory and excitatory function within the same corpus callosum.
Analogues of skin dose include entrance surface air kerma at the location of the patient’s skin pre hypertension pathophysiology order 2.5mg norvasc otc. Azienda Ospedaliero-Universitaria Santa Maria della Misericordia blood pressure 60 over 30 10mg norvasc visa, Italy Cotelo blood pressure medication extreme tiredness buy discount norvasc, E arteria jugularis externa norvasc 5 mg amex. Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Italy Pernicka, F. Universidad Complutense de Madrid, Spain Consultants Meetings Vienna, Austria: 24–28 June 2002, 20–24 October 2003, 20–24 June 2005 147. C of its Statute, makes available and fosters the exchange of information relating to peaceful nuclear activities and serves as an intermediary among its Member States for this purpose. It seeks to contribute to the scientific debate as to whether guidance le vels can be derived from and applied to complex X ray procedures such as interventional procedures using X rays. It also certify that this work has not been presented previously to any other University for award of degree, diploma or other recognition. P, Senior lecturer in nursing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum. Her advice regarding to the concept, basic guidelines and analysis of data were very much encouraging. Her contributions and suggestions have been of great help for which I am extremely grateful. With profound sentiments and gratitude the investigator acknowledge the encouragement and help received from the following persons for the completion of this study. All the staffs and departmental head of Cardiology unit, helped me for the completion of this study at some time I am indebted to them. Background: Cardiac catheterization is an invasive procedure which is used in the diagnosis and treatment of several cardiac diseases. It may lead to several major and minor complications which may contribute to morbidity and mortality. Early recognition of complications and proper care is logically tied to taking action to receive prompt treatment and thus minimizing further complications. Objectives: (i) To assess the knowledge level of cardiac nurses related to patient safety after cardiac catheterization. Method: A survey was conducted in 30 convenient samples with a pre-validated questionnaire and an observational tool was also used in assessing the quality of care provided. The study population was staff nurses from cardiology medical intensive care unit and cardiology medical ward. Result: the knowledge level is higher in staff nurses who has experience more than 5 years compared to those whose years of experience is less than 5 years. On observing the practices; quality of care is adequate Conclusion: the study showed that the knowledge level increases with years of experience. One or more catheters is inserted through a peripheral blood vessel in the antecubital artery or vein or femoral artery or vein with x-ray guidance. A test that can be performed on either side of the heart, cardiac catheterization checks for different functions in both the left and right sides. Left-sided heart catheterization is performed by way of a catheter through an artery which tests the blood flow of the coronary arteries, function of the mitral and aortic valves, and left ventricle. Some complications occurs during the transfer of patients after cardiac catheterization or delayed or inadequately provided care. Patient safety is defined as being free from accidental harm as a result of a health care encounter. It is the responsibility of the cardiac catheterization team to make that commitment to every patient and to each other. A well-functioning unit with a culture of safety, demonstrated clinical quality outcomes, and high internal/external customer satisfaction scores can avoid the risks associated with a less reliable unit. Major predictors of such complications following coronary interventional procedures include advanced age, repeat 1 percutaneous transluminal coronary angioplasty, female gender, and peripheral vascular disease. Minor predictors include level of anticoagulation, use of thrombolytic agents, elevated creatinine levels, low platelet counts, longer periods of anticoagulation, and use of increased sheath size (Nasser 1995). Coronary care unit is a nursing specialty that work with patient who suffer from various cardiac diseases like acute coronary syndrome,myocardial infarction, rheumatic heart disease,various arrhythmias, patient who had undergone various cardiac interventional procedures like coronary angiogram, percutaneous transluminal coronary angioplasty, percutaneous transluminal mitral commissurotomy, permanent pacemaker implantation, device closures,balloon mitral valvotomy, balloon pulmonary valvotomy etc. Cardiac nurse must assess and care for patients with cardiac problems as well as patients undergone cardiac catheterizations procedures, patient for any negative signs of a change in condition, safe transport, administering medication, help with basic personal care needs,control of bleeding, maintenance of haemostatis. Increased risk for vascular complications was found in patients who were older than 70 years, were female, had renal failure, underwent percutaneous intervention. The data collected from the cardiac unit of Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum reveals that approximately 3800 cardiac catheterization procedures are done annually. Out of this, only 3% are done as emergency procedures, while others are done electively. Complications are usually temporary and may include minor infections, bleeding, abnormal heartbeats, and reaction to medications or dye. There is also a possibility that more serious but rare problems may develop during the procedure. These major cardiac catheterization complications include heart or lung problems, stroke, heart attack, or kidney failure. The factors found to increase the risk of haematoma development can provide background for procedural changes and increase the focus on patients at increased risk in order to minimize the development of haematomas (Anderson 2005). Local vascular complications may be diminished by a cautious and sensitive puncture technique with additional care in patients at higher risk for vascular complications (Heintzen M P 1998). Vascular access site complications may be reduced by early sheath removal, by avoiding placement of venous sheaths and by limiting heparin dosing to avoid excessive activated clotting times. Angio Seal and Prostar obtain a fast vascular access hemostasis after interventional procedures, with a low incidence of major vascular complications. Cardiac nurses are responsible for providing patient’s safety and minimizing vascular complications after cardiac catheterization procedures. Each nurse should know the high risk patient, safe practices for handling and maintenance of homeostasis. Hence the investigator planned to conduct a study to assess the knowledge of cardiac nurses on safety practices after cardiac catheterization procedures in cardiac unit 1. To identify the knowledge of nurses related to patient safety after cardiac catheterization. Subsets of this technique are mainly catheterization involving the catheterization of the coronary arteries, and catheterization of cardiac chambers and valves. Safety: the state of being secure or safe from injury, harm, or loss; a judgment of the acceptability of risk–a measure of the probability of an adverse outcome and its severity associated with using a technology in a given situation Knowledge: A state of awareness or understanding with conscious mind. In this study, investigator assesses the knowledge on safe practices of nurses after cardiac catheterizations. Practice: Repeated performance or systematic exercise for the purpose of acquiring skill or proficiency. In this study, investigator assess the practice of nurses on safety after cardiac catheterization using a structured questionnaire. Patient safety is a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical error that often leads to adverse health events. In this study, patient safety means minimizing complications in patients after cardiac catheterization. The investigator also assess the practices of nurses in cardiac unit about safety practices after cardiac catheterizations using a checklist. In this chapter, the background of the study is outlined, the subject assessing the nurse knowledge and practice about safety practices after cardiac catheterization procedures is briefed, the need and significance of research problem stressed, and problem and objectives are stated. An attempt is made to operationally define the terms, so as to clarify a brief discussion on methodology adopted for the study. It refers to a broad, comprehensive, in-depth, systematic and critical review of scholarly publications, unpublished scholarly print materials and audio visual materials. A review of literature is an essential activity of scientific research projects, which provides a basis for future investigation, justify feasibility of the study, indicate, constraints of data collection and helps to relate findings from one study to another with a view to establish a comprehensive body of scientific knowledge in a professional discipline from which valid and pertinent theories may be developed. The literature review relevant for the study is presented on the following sections: 2. In a descriptive, correlational 4010-patient study, nursing care interventions after coronary procedures were measured. Several significant correlations between nursing interventions and the occurrences of moderate to severe bleeding at the access site were found. The most significant factors in decreasing complications at the access site were early removal of the arterial sheath, the type of pressure mechanism used to achieve arterial hemostasis, staffing allocation, and the person and method used to remove the sheath.
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