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Experience of a heart transplant from patient´s perspective.
MAZÁK, Vít
This bachelor thesis deals with the topic of the experience of the whole process of a heart transplant from the patient's perspective. The aim of this thesis is to map the needs of patients during the process of heart transplantation. This goal was achieved using research questions about how the patient perceives nursing care, what feelings they experience, what their needs are and subsequently how they comply with the precautions after the heart transplant. The theoretical part focuses on the history of organ transplantation with a closer look on the history of heart transplantation and approaches the transplantation law in the Czech Republic, and includes the topic of the most common causes of a heart transplant. Then, it elaborates on the conditions of the heart transplant and the subsequent inclusions of the patient on the waiting list. It also briefly describes selected examinations preceding the heart transplantation, the patient's preparation and the general course of the operation. It explains the nursing care of the patient after the heart transplant, patient's needs and rehabilitation after the surgery and early complications. After that, the thesis follows up with describing the nursing care in the hospital and the patient's home rehabilitation. It also focuses on the psyche during the transplantation process, on the description of immunosuppressive drugs and the contexts of their use. The research part of this work utilizes the qualitative research method. A semi-structured interview consisting of 29 questions was used to collect the data. The research group consisted of six patients, who have undergone a heart transplant. During the research that was to map the needs of informants, it has become clear that the needs of a heart transplant patient are usually met thanks to the high level of nursing care, which is provided to them. The quality of nursing care identified in this cases is highly adapted to the individual needs of the interviewed. Most patients do not have a problem receiving a foreign organ, but in some cases they would need more time to absorb a fact, that it is an organ from other human. What emerged from other results is, that some patients have a feeling they are insufficiently informed about the heart transplantation before the operation itself.
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Experimental and clinical aspect of calcineurin inhibitors-induced nephrotoxicity.
Hošková, Lenka ; Málek, Ivan (advisor) ; Tesař, Vladimír (referee) ; Špinarová, Lenka (referee)
The introduction of calcineurin inhibitors (CNI) into immunosuppressive regimens significantly improved patients prognosis after heart transplantation. Some of the most significant complications have been recognized, such as the development of arterial hypertension and renal impairment due to calcineurin inhibitor toxicity. The aim of the study was to compare the effect of the dual blockade of the renin-angiotensin system (dual RAS combination) with standard antihypertensive medication on blood pressure control. The second aim was to evaluate whether effective antihypertensive combination therapy (dual RAS or a standard antihypertensive drugs combination) would reduce the progression of chronic kidney disease in patients with chronic immunosuppressive prophylaxis. Treatment of arterial hypertension involving the combination of angiotensin-converting enzyme inhibitor (ACEi) and angiotensin II receptor blocker (ARB) was similarly effective compared to the standard combination of antihypertensives. Blood pressure treatment targets were achieved in both studies. Administration of antihypertensive combination therapy including dual blockade of RAS alleviated the progression of chronic renal disease in the experimental and clinical part, where the nephroprotective effect of dual RAS blockade...
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Gender differences in myocardial apoptosis of the patients after heart tranplantation.
Smetana, Michal ; Szárszoi, Ondrej (advisor) ; Brát, Radim (referee) ; Neckář, Jan (referee)
Gender differences in myocardial apoptosis of the patients after heart transplantation Background: Many functions of the cardiovascular apparatus are influenced by gender. The aim of our study was to find out the sensitivity to perioperative ischemia of the donor female and male myocardium; and determine how the organism affects the donor myocardium of the other sex after heart transplantation (detection of apoptosis), and whether the investigated biomarkers can predict primary graft dysfunction (PGD). Methods: The research was divided into three prospective studies. The Study 1 included 81 patients undergoing heart transplantation from September 2010 to January 2013. Patients were divided into two groups according to male allograft and female allograft. In order to prove myocardial necrosis the high-sensitive cardiac troponin T (hs-cTnT) method was used. Apoptosis was determined by immunohistochemical detection of caspase-3, Bcl-2, and by the TUNEL method. The Study 2 includeded 58 patients divided into four groups according to gender; both of the recipient and the donor. Apoptosis (caspase-3, Bcl-2, TUNEL) was analysed in these groups during the two-year follow-up. Into Study 3 64 patients were involved. We investigated the relationship in between these biomarkers and the development of PGD after...
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Heart transplantation in the Czech republic by economic view: international comparison
Havlíková, Marie ; Janíčko, Martin (advisor) ; Čermáková, Klára (referee)
In my bachelor thesis, I primarily focus on the economy of heart transplantation. At first there is an important topic of health economy and its specific features. Then I go deeper in the topic and mention the economy of transplantation, supply and demand of organs and define donors and the recipients of organs. I also describe the legal system of transplantation and organ donation and mention the history of heart transplantations (HTX). The second part of my thesis is concerned with the situation of heart transplantations in the USA. I compare how the situation about HTX changed there during the last decades and how is it with the costs and payments. Finally, the third part of my thesis deals with the heart transplantations in the Czech Republic and another six European countries. Using the econometric model, I try to estimate the average waiting period for heart transplantation and its determinants.
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Analysis of selected genetic markers in patients after heart transplant
Petříková, Nikola ; Hubáček, Jaroslav (advisor) ; Vrablík, Michal (referee)
Heart transplantation is performed in patients with end-stage heart failure, in whom all other methods of treatment failed. The most common causes of end-stage heart failure are dilated cardiomyopathy and coronary artery disease. The destiny of these patients is highly variable. Prediction of long term survival in patients after heart transplantation is not satisfactory and up to now has not been found reliable marker. Most of the patients die after heart transplantation due to cardiovascular disease. This thesis is focused on molecular genetics and statistical analysis of four single nucleotide polymorphisms, namely rs17817449 (16q12.2, FTO gene), rs2943634 (2q36.3; intergenic region), rs6922269 (6q25.1; MTHFD1L gene), and rs10757274 (9p21.3; intergenic region). According to genome wide association studies are these SNPs assosiated with cardiovascular diseases. We genotyped DNA samples of 364 heart donors and 364 heart recipients. The results were statistically compared (using OR and Pearson's χ2 test) with the control group, which consisted of samples of individuals from the general population MONICA study. We examined the genotype in patients whose hearts failed due to dilated cardiomyopathy or coronary artery disease and then in patients with cardiac allograft vasculopathy. Furthermore, we focused on...
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Problems of patients with long-term cardiac support
Ondráčková, Lucie ; Pavlíková, Pavla (advisor) ; Černá, Alena (referee)
Bachelor thesis is divided into theoretical and empirical part. The theoretical part is devoted to heart failure, given that it is patients with end stage heart failure is a long-term cardiac support implemented. It is described surgical treatment of heart failure and various cardiac support. A separate section is devoted to long-term cardiac support-Heart Mate II. Conclusion The theoretical part is devoted to the specifics of treatment of patients with established long-term cardiac support. The empirical part of the paper maps out the problems of patients with established long- term cardiac support. The method used to implement the survey questionnaire. The studied group consisted of 21 patients with established long-term cardiac support in outpatient care. Reconnaissance survey conducted in the outpatient department of heart failure IKEM in Prague. The work shows that although the introduction of cardiac support for patients and mentally demanding affects their daily life, most of them feel improvements in your health and well-established cardiac support perceived as a chance to wait for a heart transplant.
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Nursing care for pacients with heart transplantation.
VINKLEROVÁ, Petra
The bachelor thesis focuses on the issues of nursing care of patients with heart transplantation. The first heart transplantation in the Czech Republic was performed in IKEM, Prague in 1984. There are seven transplantation centres in the Czech Republic, but only those in Prague and Brno perform heart transplantation. The thesis is divided into a theoretical and a practical part, while the theoretical part also deals with the anatomy, history and characteristics of transplantation. Heart transplantation is performed on patients with heart disease at the stage of terminal heart collapse. A recipient has to meet some conditions for the transplantation. He/she has to be added to a register on the waiting list, must have the same blood group as the donor, similar weight and be less than fifty five years old. A suitable donor is necessary. Another condition is that all the conditions of Act No. 285/2002 Col. as amended have to be met. The fact that the donor is not in the national register of persons not agreeing with post mortem organs or tissues donation has to be excluded and his/her identification has to be confirmed. Before a patient is added to the waiting list he/she undergoes detailed examination to determine the urgency of addition to the waiting list. As transplantation is considered an acute surgical intervention the recipient only undergoes an immediate body preparation before the operation when a suitable donor is found. The theoretical part then describes heart removal from the donor, the operation procedure and heart transplantation techniques. There are three heart removal techniques nowadays. The biggest attention is paid to postoperative care. It includes endomyocardial biopsy, which is done in regular intervals, control visits and administration of immunosuppressive drugs. Post transplantation complications that might occur in early or later postoperative period are also dealt with there. Postoperative care also includes education in postoperative regimen. The main goal of the thesis was to map the specifics of nursing care of patients after heart transplantation both before and after operation. A partial goal was to find out in what way patients are given information on postoperative regimen after heart transplantation. The thesis also endeavours to determine the difference between nursing care provided to patients after heart transplantation and after cardiac surgical operation. The empiric part of the thesis involved qualitative research, for which research questions had been set. The research sample consisted of seven nurses. Four nurses were from the Institute for Clinical and Experimental Medicine in Prague and three from cardiac surgery department of the České Budějovice Hospital. The research had the form of non-standardized interview at a nurse daily room and one in domestic environment. The results are based on the interviews and were processed by means of categorized groups. The results show that nursing care of patients after heart transplantation does not differ from that of patients after cardiac surgery operation. There are differences between examinations of patients before heart transplantation. We may see them in the most important preoperative examinations. They include special taking of antibodies as they define the intensity of administered immunosuppressive medication. The difference in postoperative care is in regular medical checkups. There are big differences in social contacts between patients and their environment. Provision of detailed information to the patient is an important part of the nursing care. Information should be provided during both preoperative and postoperative care. The other spheres are identical. The thesis should be beneficial for nurses caring of patients after heart transplantation, but also for those who are deciding whether to undertake heart transplantation or are more closely interested in the problems of heart transplantation.
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