Download 6.5.4 Lipid lowering agents - Rajiv Gandhi University of Health

SYNOPSIS FOR REGISTRATION OF
SUBJECT FOR DISSERTATION
SUBMITTED BY:
Ms. PHEEBA JOY
I M.SC NURSING
MEDICAL SURGICAL NURSING
(2012-2014 BATCH)
FORTIS INSTITUTE OF NURSING
#20/5, YELACHENAHALLI, KANAKAPURA ROAD
BANGALORE-560078
SYNOPSIS FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1.
NAME OF THE
Ms. PHEEBA JOY,
CANDIDATE AND
I YEAR M.SC NURSING,
ADDRESS
FORTIS INSTITUTE OF NURSING,
#20/5,YELACHENAHALLI,
KANAKPURA MAIN ROAD,
BANGALORE-560078
2.
3.
4.
NAME OF THE
FORTIS INSTITUTE OF NURSING,
INSTITUTION
BANGALORE
COURSE OF THE
MASTERS DEGREE IN NURSING,
STUDY AND SUBJECT
MEDICAL SURGICAL NURSING.
DATE OF ADMISSION
15 JUNE-2012
TO THE COURSE
5.
TITLE OF THE STUDY
A STUDY TO ASSESS THE
EFFECTIVENESS OF
STRUCTURED TEACHING
PROGRAM ON KNOWLEDGE
REGARDING LIPID LOWERING
AGENTS AMONG PATIENTS WITH
CORONARY ARTERY DISEASE
ADMITTED IN SELECTED
HOSPITALS, BANGALORE.
1
6. 0 BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
A healthy heart can be result of few factors, which includes good
genes, good physical activities, right meal and food choices etc. Nothing can
be done with once genes, they are God gifted and beyond the control of
human being. But, about others they can be easily controlled by normal life
style and healthy food practices.1
Old age saying "we are what we eat" is more true today than it ever
was when you consider the vast choices of processed and chemically
enhanced foods available to us.2 Diet has an important role to play in Indians
as they are prone to cardiac diseases particularly atherosclerosis related
ischemic episodes. The dietary pattern, eating and methods of cooking vary
in different parts of India.3
According to the World Health Organization nearly 17.5 million lives
are lost due to the heart disease worldwide, and in the race Indians are again
running fast as American and others. According to WHO estimates about
60% of the total worlds cardiac patients are Indians, Americans are also
leading in the list issued by them.1 Despite recent advances in the diagnosis
and treatment of cardiovascular disease (CVD), it remains the leading cause
of death.4
ALARMING STATISTICS in India suggest that India will have the
largest cardiovascular disease burden in the world. One fifth of the deaths in
India are from coronary heart disease. By the year 2020, it will account for
one third of all deaths. Sadly, many of these Indians will be dying young.
Heart disease in India occurs 10 to 15 years earlier than in the west. There
2
are an estimated 45 million patients of coronary artery disease in India.
An increasing number of young Indians are falling prey to coronary artery
disease. With millions hooked to a roller-coaster lifestyle, the future looks
even grimmer.5
On September 2011, the United Nations General Assembly
convened a landmark high level meeting on non communicable disease,
cardiovascular disease (CVD) was high on agenda. The potential health and
financial benefits of CVD prevention are astonishing. Each year CVD kills
about 20 million people, including 10 million prematurely [before age 65]
and inflicts high morbidity, disability and socio economic costs. In high
income countries, preventing or postponing 100 cases saves about $1million.
Also diet is a powerful common determinant of CVD. Natural experiments
have shown rapid reduction in CVD after dietary improvements in
population. So they suggested an internationally coordinated and promoted
initiative to improve these dietary targets would powerfully reduce the risk
of CVD and promote public and economic health.6
In 1985 the National Heart, Lung, and Blood Institute launched the
National Cholesterol Education Program (NCEP), which issued the Adult
Treatment Panel (ATP I, II, and III) clinical guidelines aimed at reducing the
burden of CVD through improved cholesterol management. The NCEP
produced educational kits for clinicians and patient-oriented media
programming including the “Know Your Cholesterol Numbers, Know Your
Risk” campaign. Cholesterol knowledge is reported to have improved since
the 1980s, but important information gaps remain.4
3
Unfortunately, there are no symptoms of high cholesterol and most
people are unaware that their cholesterol levels are too high until they suffer
a heart attack or they suffer a stroke.7 So it is essential to know the
cholesterol level and take measures to lower it. Treatment for high
cholesterol levels usually begins with changes in daily habits. By losing
weight, stop smoking, exercising more and reducing the amount of fat and
cholesterol in the diet, many people can bring their cholesterol levels down
to acceptable levels. However, some may need to use cholesterol-reducing
drugs to reduce their risk of health problems.8
Researchers suggest that the prevalence of CAD among urban south
Indians is increasing rapidly. Urgent steps are needed to modify the life style
by increasing physical activity, modifying diet and perhaps making
aggressive use of statins as a part of preventive strategy to reduce risk
factors and thus the burden of CAD in this population.9
6.1 NEED FOR THE STUDY
According to WHO the prevalence of Coronary Heart Disease is 3%
in rural and 7% in urban; roughly 50 million are estimated to have this
disease. Heart Attack and stroke account for 30% of total death due to
diseases.
CAD
is
becoming
largest
disease
burden
in
India.5
Hypercholesterolemia is a major risk factor for cardiovascular disease and
many studies show that control of elevated cholesterol reduces the
occurrence of cardiovascular events.10
Cholesterol is a type of fat (lipid), found both in the body and in
certain foods. It has spent its fair share of time in the news because of its
4
association with heart disease and stroke, but in fact, cholesterol is a vital
substance, found in the blood and in every cell of the body. It is one of the
building blocks of cell membranes and the body uses it to make vitamin D
and hormones. Too much cholesterol in the blood can increase the risk of
heart disease and stroke by leading to a buildup of plaque on artery walls.
Eventually, the plaque can narrow the arteries (atherosclerosis), reducing
blood flow. If a blood clot forms and blocks an artery to the heart, a heart
attack can occur. If a blood clot blocks an artery to or in the brain, a stroke
results. The trick is to ensure that the person have the right balance of
cholesterol in the blood. If the cholesterol level is too high, making simple
dietary and lifestyle changes – such as eating less fat and increasing physical
activity – can lower the cholesterol and therefore the risk of heart disease
and stroke.11
New research suggests that cholesterol-friendly foods, such as soy
products and tree nuts, may contribute to lowering LDL or "bad," cholesterol
level.12
A randomized control trial conducted on effect of portfolio of
cholesterol lowering foods in hyperlipidemia patients. They selected 351
dyslipidemic patients across Canada and given dietary incorporation of plant
sterols, soya protein, viscous fiber and nuts for a period of six months. They
found a greater reduction in LDL and suggested that use of a dietary
portfolio compared with low saturated fat dietary advice resulted in greater
reduction of LDL.13
Another research study proposed that portfolio diet reduces the LDL
level in the blood. It also suggests that by careful food component selection,
appropriate to the individual, the effect of including only two components in
the diet with good compliance could bring a sustainable reduction of 10% in
5
LDL-cholesterol; this is sufficient to make a substantial impact on
cholesterol management and reduce the need for pharmaceutical
intervention.14
There is strong evidence that certain food can have lipid lowering
effect. But people lack knowledge regarding this.
An epidemiological study conducted in Jaipur, India to determine
cardiovascular risk and educational status. They categorized 1280 adults into
low, middle and high educational status and found that low and middle
educational status urban subjects in India have greater cardiovascular risk.
This points to educate people regarding risk of cardiovascular disease
especially about lipids and tips to manage high lipid level.15
Further a study conducted in Paris to determine the perception,
educational need of patient about hypercholestremia and suggest that
physician–patient communication is sub-optimal and highlights the need to
improve educational material for cardiovascular disease prevention. This
analysis helps to identify appropriate educational objectives and methods for
patients at risk of cardiovascular disease, and develop a structured
educational program. This suggest a need for structural teaching program for
cardiac patients.10
A research conducted by Self administered questionnaires suggests
that further efforts are required, however, to educate the public about the
risks associated with a high dietary fat intake.16
Investigator also felt that there is a lack of knowledge regarding lipid
lowering agents and management of hyperlipidemia through clinical
experience. Therefore researcher aims to assess the knowledge of patients
diagnosed as CAD regarding lipid lowering agents and provide a structured
teaching program to enhance their knowledge regarding lipid lowering
6
agents and its impact on serum lipid levels. Thus helps the patients to reduce
the risk of CAD.
6.2 REVIEW OF LITERATURE
6.2.1 Reviews related to lipid lowering diet
A study conducted on ‘a dietary portfolio for management and
prevention heart disease’ in Toronto to evaluate the combination of four
dietary components that have been shown to lower blood cholesterol
concentrations (nuts, plant sterols, viscous fiber and vegetable protein) in a
dietary portfolio in order to determine whether the combined effect is
additive. In 2010 he reported that in a metabolically-controlled setting this
dietary portfolio has proved to be as effective as a starting dose of a firstgeneration statin cholesterol-lowering medication in reducing the risk of
CAD. The dietary portfolio has also been shown to be effective in sustaining
a clinically-significant effect in the long term under a 'real-world' scenario.
The evidence supports the beneficial role of the dietary portfolio in reducing
blood cholesterol levels and CAD risk.17
Another study conducted on ‘Towards an improved lipid-lowering
diet: additive effects of changes in nutrient intake’ to identify diets that are
more effective than existing ones in reducing lipoprotein mediated risk of
atherosclerotic heart disease. The serum lipid and lipoprotein response to
three modified diets was studied in twelve normal men living in an
institution. The "Western" reference diet (40% energy from fat, diet A) was
compared with a fat-modified diet (diet B, 27% energy from fat, reduced
cholesterol content); with a fat-modified diet supplemented with fruit,
vegetable, and cereal fiber (diet C); and with a diet providing 40% energy
7
from fat, having and supplemented by fiber (diet D). The effects of fat
modification and fiber-supplementation (diets C and D) were strongly
additive-a fall in serum cholesterol by 24-29%, in low-density-lipoprotein
(LDL) cholesterol by 31-34%, and the additive effects of multiple changes
in nutrient intake, each moderate in extent, permits the design of diets which
are remarkably effective in reducing serum-cholesterol level.18
A study conducted in Canada to know the effectiveness of individual
component in dietary portfolio advised by National cholesterol education
program. They assessed the effect of eliminating one out of the four dietary
portfolio components. Plant sterols were selected because at 2 g/d, they have
been reported to reduce low-density lipoprotein cholesterol (LDL-C) by 9%
to 14%. Forty-two hyperlipidemic subjects were prescribed diets high in soy
protein, viscous fiber, and almonds for 80 weeks. Subjects were instructed to
take these together with plant sterols except between weeks 52 and 62.
While taking the full dietary portfolio, including plant sterols, mean LDL-C
reduction from baseline was 15.4% +/- 1.6%. After sterol elimination, mean
LDL-C reduction was 9.0% +/- 1.5%. In combination with other cholesterollowering foods and against the background of a low-saturated fat diet, plant
sterols contributed over one third of the LDL-C reduction seen with the
dietary portfolio after one year of following dietary advice.19
A randomized controlled trial was conducted in Australia to know the
effectiveness of lipid lowering diet of oats and reported in 2012 intake of
oats β-glucan is effective. A six week randomized controlled trial was
conducted in eighty-seven mildly hypercholesterolemia men and women
assigned to one of three diet (25 % energy (E%) ; 45 E% carbohydrate; 30
E% fat, at energy requirements for weight maintenance): and first group
8
with minimal β-glucan (control); second group with low-dose oat β-glucan
and third group with higher dose oat β-glucan. Changes in total cholesterol
and LDL-cholesterol (LDL-C) from baseline were assessed. Total
cholesterol reduced significantly in all groups in the OH, OL and control
groups), as did LDL-C but between-group differences were not significant.
In responders only (n 60), β-glucan groups had higher reductions in LDL-C;
P = 0·044). Intakes of oat β-glucan were as effective at doses of 1·5 g/d
compared with 3 g/d when provided in different food formats that delivered
similar amounts of soluble β-glucan.20
Further a study conducted to determine the effectiveness of
consuming a combination of cholesterol-lowering foods (dietary portfolio)
under real-world conditions.
For twelve months, 66 hyperlipidemic
participants were prescribed diets high in plant sterols (1.0 g/1000 kcal), soy
protein (22.5 g/1000 kcal), viscous fibers (10 g/1000 kcal), and almonds (23
g/1000 kcal). At three month and one year, mean
LDL-cholesterol
reductions appeared stable at 14.0 ± 1.6% (P < 0.001) and 12.8 ± 2.0% (P <
0.001), respectively (n = 66). 31.8% of the participants (n = 21 of 66) had
LDL-cholesterol reductions of >20% at one year. By this they concluded
that more than 30% of motivated participants who ate the dietary portfolio of
cholesterol-lowering foods under real-world conditions were able to lower
LDL-cholesterol concentrations >20% .21
6.2.2 Review related to lipid lowering diet and statins
A study conducted to compare the effectiveness of dietary portfolio of
cholesterol lowering food and statin. Participants were randomly assigned to
undergo one of three interventions on an outpatient basis for one month: a
diet very low in saturated fat, based on milled whole-wheat cereals and low-
9
fat dairy food (control); the same diet plus lovastatin, 20 mg/d; or a diet high
in plant sterols, soy protein, viscous fibers and almonds (dietary portfolio).
They found that the control, statin, and dietary portfolio groups had mean
(SE) decreases in low-density lipoprotein cholesterol of 8.0% (P =.002),
30.9%(P<.001), and 28.6%(P<.001) respectively. The significant reductions
in the statin and dietary portfolio groups were all significantly different from
changes in the control group. There were no significant differences in
efficacy between the statin and dietary portfolio treatments, suggesting the
combined intake of statins and dietary portfolio in lowering the cholesterol
level. 22
6.2.3 Review related to statin
Low-density lipoprotein (LDL) cholesterol is an established risk factor
for coronary heart disease (CHD). In the presence of oxidative stress LDL
particles can become oxidized to form a lipoprotein species that is
particularly
atherogenic.
Indeed,
oxidized
LDL (oxLDL)
is
pro-
inflammatory, it can cause endothelial dysfunction and it readily
accumulates within the arterial wall. Reducing oxidative stress has been
proposed as a potential approach to prevent CHD and antioxidant vitamins
have been employed with encouraging results in experimental models of
atherosclerosis. Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase
inhibitors) are the first-line choice for lowering total and LDL cholesterol
levels and they have been proven to reduce the risk of CHD. Recent data
suggest that these compounds, in addition to their lipid-lowering ability, can
also reduce the production of reactive oxygen species and increase the
resistance of LDL to oxidation. It may be that the ability of statins to limit
10
the oxidation of LDL contributes to their effectiveness at preventing
atherosclerotic disease.23
A prospectively investigated study conducted to know whether lipidlowering therapy with a cholesterol synthesis enzyme inhibitor reduces the
progression of coronary calcification. In 66 patients with coronary
calcifications in electron beam tomography (EBT), LDL cholesterol >130
mg/dl, and no lipid-lowering treatment, the EBT scan was repeated after a
mean interval of 14 months and treatment with cerivastatin was initiated (0.3
mg/d). After 12 months of treatment, a third EBT scan was performed.
Coronary calcifications were quantified using a volumetric score.
Cerivastatin therapy lowered the mean LDL cholesterol level from 164±30
to 107±21 mg/dl. One-year 20-mg atorvastatin treatment induced regression
of thoracic aortic plaques with marked LDL cholesterol reduction.24
11
6.3 STATEMENT OF THE PROBLEM
A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAM ON KNOWLEDGE REGARDING LIPID
LOWERING AGENTS AMONG PATIENTS WITH CORONARY
ARTERY
DISEASE
ADMITTED
IN
SELECTED
HOSPITALS,
BANGALORE.
6.4 OBJECTIVES
1. To assess the knowledge of patients with Coronary Artery Disease
regarding lipid lowering agents by conducting pre-test
2. To evaluate the effectiveness of structured teaching program on
knowledge of patients with Coronary Artery Disease regarding lipid
lowering agents by conducting post-test
3. To find out the association between post-test knowledge scores of
patients with Coronary Artery Disease with selected demographic
variables.
6.5 OPERATIONAL DEFINITIONS
6.5.1 Assess:
In this study it refers to the statistical measurement of knowledge of
patients diagnosed as CAD regarding lipid lowering agents.
6.5.1 Effectiveness:
12
In this study it refers to the extent to which structured teaching
program on lipid lowering agents is effective in improving the knowledge
scores of patients diagnosed as CAD.
6.5.2 Structured teaching program:
It refers to the systematically organized, individualized instruction
prepared to educate patients with coronary artery disease regarding lipid
lowering agents and its importance in preventing the risk of cardiovascular
disease.
6.5.3 Knowledge:
It refers to awareness and understanding of patients with coronary
artery disease regarding lipid lowering agents which covers the general
information about lipid lowering food items and medicine and its role in
prevention of cardiovascular disease.
6.5.4 Lipid lowering agents:
This includes the food items such as oats, garlic, nuts, strawberry,
plant sterols, soya bean, green tea and drugs which have got a lipid lowering
effect.
6.5.5 Patients with coronary Artery Disease (CAD):
It refers to the persons who are suffering from coronary artery
disease (angina pectoris or myocardial infarction) and admitted in cardiology
wards of selected hospitals, Bangalore.
6.6 ASSUMPTIONS
1. Patients with CAD may have inadequate knowledge on importance of
lipid lowering agents including food items.
13
2. Structured teaching program on lipid lowering agents for patients with
CAD may help in improving their knowledge and thereby reduces
complications.
14
6.7 HYPOTHESIS
H0:
There is no significant difference between pre-test and post-test
level of knowledge regarding lipid lowering agents.
H1:
The mean post test knowledge scores of the patients with CAD
after the structured teaching program is significantly higher than
the mean pre-test knowledge score.
H0.1: There is no significant association between post-test knowledge
scores of patients with CAD on lipid lowering agents
with selected demographic variables
H1.1: There is significant association between post test
knowledge scores of patients with CAD on lipid lowering agents
with selected demographic variables.
6.8 VARIABLES IN THE STUDY
Dependent variables:
Knowledge scores of patients with CAD on
lipid lowering agents.
Independent variables:
Structured teaching program on lipid
lowering agents for patients with CAD
Demographic variables:
It consists of baseline information of
patients with CAD such as age, gender,
religion, educational status, occupation,
income, marital status, place of residence,
dietary habits, personal habits (smoking,
alcohol, and exercise), age at diagnosis of
CAD,
duration
of
illness,
associated
illness, current medications, use of any
15
other lipid lowering agents, source of
information.
7. 0 MATERIALS AND METHODS
7.1.1 source of data:
The data will be collected from the patients
diagnosed as CAD who are admitted in
cardiology wards of
selected hospitals,
Bangalore.
7.1.2 Research approach:
The approach used in this study is
evaluative approach.
7.1.3 Research design:
Quasi experimental study with one group
pre-test and post-test design without control
group.
7.1.4 Setting of the study:
Cardiology wards of selected hospitals,
Bangalore.
All patients diagnosed as having coronary
7.1.5 Population:
artery disease.
Patients diagnosed as having CAD in
7.1.6 Sample:
cardiology wards of selected hospital,
Bangalore.
7.1.7 Sampling
technique: Non
probability
purposive
sampling
technique.
7.1.7 Sample size:
Patients CAD who fulfill the certain
inclusion criteria are selected for the study.
The sample size is 60.
16
7.1.8 Sampling criteria
Inclusion criteria:
1. Patients with diagnosed with CAD (angina
pectoris, MI).
2. Patients, who can read, write and
Understand English language.
3. Patients who are willing to participate.
Exclusion criteria:
1. Patients who develop complications like
congestive cardiac failure, pulmonary
edema and respiratory distress.
2. Patients who are critically ill and not able to
comprehend.
7.2.1 TOOL FOR DATA COLLECTION
The tool consists of three sections:
Section A:
Demographic data of patient diagnosed as CAD such as age,
gender, religion, educational status, occupation, family
income, marital status, place of residence,
dietary habits,
personal habits (smoking, alcohol, exercise), age at diagnosis
of CAD, duration of illness, associated illness, current
medications, use of any other lipid lowering agents, source of
information.
Section B:
Structured questionnaire will be used to assess the knowledge
on lipid lowering agents among patients with CAD
Section C:
Structured teaching program on role of lipid lowering agents
in reducing risk of CAD.
17
7.2.2 METHOD OF DATA COLLECTION
After obtaining permission from the concerned authorities and
informed consent from the samples, the data will be collected in three
phases:
Phase I – A pre test will be administered to patients with CAD using
a questionnaire to assess their knowledge on lipid lowering agents.
Phase II – A structured teaching program on lipid lowering agents
will be conducted on the same day immediately after the pre-test.
Phase III – After an interval of seven days, post test will be
conducted for the sample using the same questionnaire for evaluating
the effectiveness of structured teaching program.
7.2.3 METHOD OF DATA ANALYSIS
The data collected will be analyzed by means of descriptive statistics
and inferential statistics.
 Descriptive statistics
- Mean, mean percentage, median and standard deviation will be
used to assess the level of knowledge regarding lipid lowering
agents of patients diagnosed as CAD.
- The results will be represented by tables and graphs.
 Inferential statistics
Paired ‘t’ test will be used to compare the pretest and posttest
knowledge, chi-square test will be used to find out the association
of post test knowledge on lipid lowering agents among patients
with CAD with selected demographic variable.
18
7.3 Does the study require any investigation or interventions to be
conducted on patients or other human or animals?
Yes, planned teaching program will be administered as an
intervention for the patients with CAD.
7.4 Has ethical clearance been obtained from the institution?
1. The ethical clearance is obtained from the committee of Fortis
Institute of Nursing.
2. Written consent will be obtained from the concerned authorities of
selected hospitals.
3. Informed consent will be obtained from the samples who are
involved in the study before collecting the data.
19
8. LIST OF REFERENCES
1. Dipak. Importance of your heart and ways to save your heart.
Available from:
URL:http://ursdipak.hubpages.com/hub/Importance-of-your-heartand-ways-to-save-your-heart
2. Food
for
health
and
disease
prevention.
Available
from:
URL:http://www.bestveganguide.com/food-for-health.html
3. Mitra Analava, Pradhan Rangadhar and Mukherjee Sutapa. Importance
of Heart-Healthy Diet. journal of human ecology 2009; vol.27:page
no.53-61: Available from: URL:http://www.krepublishers.com/02Journals/JHE/JHE-27-0-000-09-Web/JHE-27-1-000-09-AbstPDF/JHE-27-01-053-09-1771-Mitra-A/JHE-27-01-053-09-1771Mitra-A-Tt.pdf
4. Goldman E. Roberta , Parker R Donna. , Eaton B Charles , Borkan M
Jeffrey, Gramling Robert, Cover T Rebecca, et al. Patients’
Perceptions of Cholesterol. US National Library of Medicine 2006
may; vol 4(3):Pg no. 205-212. Available from:
URL:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1479442/
5. Alarming Statistics from India. Available from:
URL:http://neocardiabcare.com/alarming-statistics-india.htm
6. Dariush Mozaffarian, Simon Capewell. UN’s dietary policies to
prevent cardiovascular disease. BJM 2011 September; vol.343:p.1213.
7. Cholesterol,Why It Is Important To Lower Your Cholesterol Levels.
2007. Available from:
URL:http://www.trinityprimarycare.com/Services/Cholesterol.aspx
20
8. Cholesterol lowering drugs. medical dictionary.
Available from:
URL:http://medical-dictionary.thefreedictionary.com/CholesterolReducing+Drugs
9. Mohan Viswanathan, Deepa Raj, Rani Shanthi Subramaniam,
Premalatha Gopal. Prevalence of coronary artery disease and its
relationship to lipids in a selected population in South India. JAC
2001 Sep;vol 38:p682-687.
10. Durack-Bown Isabelle , Giral Philippe , d'Ivernois Jean-François ,
Bazin Cecile , Chadarevian Rita , Benkritly Asri et.al. Patients' and
physicians' perceptions and experience of hypercholesterolaemia: a
qualitative study. BJM 2003 nov; vol 54(496):p.851-857.
11. Lowering your cholesterol through diet and lifestyle. Ontario Ministry
of Health and Long Term care. Available from: URL:
http://www.mhp.gov.on.ca/en/healthy-eating/cholesterol.asp
12. Consumption of cholesterol-lowering food keeps cholesterol down.
2011 aug 24. Available from:
URL:http://english.pravda.ru/news/health/24-08-2011/118845cholesterol-0/
13. Jenkins J. A David, Jones J. H Peter, Lamarche Benoit, Kendall W. C
Cyril, Faulkner Dorothea, Cermakova Luba et al. Effect of a
Dietary Portfolio of Cholesterol-Lowering Foods Given at 2 Levels
of Intensity of Dietary Advice on Serum Lipids in Hyperlipidemia.
JAMA 2011 Aug;Vol 306(8):831-839.
14. J L Harland . Food combinations for cholesterol lowering. Epub 2012
Oct 15; vol25(2):249-266. Available from:
URL:http://www.ncbi.nlm.nih.gov/pubmed/23069003
21
15. Gupta Rajeev , Kaul Vijay , Agrawal Aachu , Guptha Soneil , Gupta
V.P. cardiovascular risk according to educational status in India.
Epub 2010 Aug 14:p 408-411
16. Silagy C, Muir J, Coulter A, Thorogood M, Roe L. Cardiovascular risk
and attitudes to lifestyle: what do patients think?. BJM 1993 jun:p
851-857
17. Esfahan Amin, J. A Jenkinsa David, Kendall W. C Cyril. A dietary
portfolio for management and prevention of
heart disease.
Proceedings of the Nutrition Society 2009 Dec 8:p 39–44.
18. Lewis B, Katan M, Merkx I, Miller N.E, Hammett F, Kay R.M et al.
The lancet 1981 Dec 12 ; Vol318(8259):1310 – 1313. Available
from:
URL:http://www.thelancet.com/journals/lancet/article/PIIS01406736(81)91339-8/abstract
19. D J Jenkins, T H Nguyen , A Marchie , D A Faulkner , Ireland C.
Effect of plant sterols in combination with other cholesterollowering foods. Epub 2008 Jan; 57(1):130-9. Available from: URL:
http://www.ncbi.nlm.nih.gov/pubmed/18078870
20. K E Charlton , L C Tapsell, M J Batterham , O'Shea J, Thorne R Beck
E, et al. Effect of 6 weeks' consumption of β-glucan-rich oat
products on cholesterol levels in mildly hypercholesterolaemic
overweight adults. Epub 2011 Aug 3; 107(7):1037-47. Available
from: URL:http://www.ncbi.nlm.nih.gov/pubmed/21810288
21. Kendall Cyril, Jenkins David, Faulkner A Dorothea , Nguyen Tri ,
Kemp Thomas , Marchie Augustine et al. Assessment of the longerterm effects of a dietary portfolio of cholesterol-lowering foods in
hypercholesterolemia. JAMA 1992; 267(24):3317-3325.
22
22. J A David, Kendall WC Cyril , Marchie Augustine,
Dorothea , Wong MW Julia,
Faulkner A
d’Souza Russell, et al. Direct
comparison of a dietary portfolio of cholesterol-lowering foods
with a statin in hypercholesterolemic participant.
Nutr 2005
feb; vol81:
2380-387.
Am J Clin
Available
from:
URL:http://ajcn.nutrition.org/content/81/2/380.short
23. R S Rosenson. Statins in atherosclerosis: lipid-lowering agents with
antioxidant capabilities. Europe PMC 2004; 173(1):1-12.Avaiable
from:
URL:http://europepmc.org/abstract/MED/15177118/reload=0;jsessi
onid=w44Ro9IEuoy9uvRvTQkv.8
24. Achenbach Stephan, Ropers Dieter, Pohle Karsten, Leber Alexander,
Thilo Christian, Knez Andreas, et al. Influence of Lipid-Lowering
Therapy on the Progression of Coronary Artery Calcification. AHA
Jl 2002; 106:1077-1082. Available from:
URL: http://circ.ahajournals.org/content/106/9/1077.short
23
9
SIGNATURE OF THE
CANDIDATE
Ms. Pheeba Joy
Study is feasible; contributes to
the body of knowledge.
10 REMARKS OF THE GUIDE
11 NAME AND DESIGNATION OF Mr. Prabhuswamy A. C.
Associate Professor
11.1 THE GUIDE
11.2 SIGNATURE
Mr. Prabhuswamy A. C.
11.3 CO-GUIDE
Prof. Shridhar K. V.
11.4 SIGNATURE
Prof. Shridhar K. V.
11.5 HEAD OF THE
DEPARTMENT
Prof. Shridhar K. V.
Principal
11.6 SIGNATURE
Prof. Shridhar K. V.
Study is feasible. The outcome of
the study contributes to the
knowledge base of nursing.
Sample size, sampling technique,
method of data collection and
analysis are appropriate to the
study design.
Prof. Shridhar K. V.
12 REMARKS OF THE
PRINCIPAL
1
2
12.1 SIGNATURE
24