ResearchProposal

Abstract

Manyarticles have stated much information on the comparison and contrastof the fibrinolytic therapy and the Primary percutaneous coronaryintervention (PCI). This study will focus on shading more light onthe pros or each procedure and the uncertain outcomes to enable theindividuals to decide which system of methods can be applied tohealth care services. The primary goal I will be looking forward toachieving is improving the health of the patients with infarctionheart conditions through proper treatment. My study will beparticular, and it will assume a cohort hospital based study design.The methods that I will employ to help me seek the proper datainclude selection of the survey population and sample sizedetermination using the Fisher`s formulae respectively. I will applydifferent inclusion and exclusion criteria to select the rightpopulation of patients who will participate in the research study. Iwill seek proper ethical approval and certification from theinstitutions, governing bodies and the ethical boards so as to avoidany inconveniences during my study.

Coronaryinfarction has become a riskier condition in most populations allover the globe. The health status of the general public determinesvery diverse activities such as the country`s gross domestic productfrom the powered labor of the professionals. When people’s healthis compromised, many adverse effects are felt in the populations. Theinfarction heart condition, therefore, has to be identified andtreated by the use of standardized procedures. The most commonly usedmethods are the fibrinolytic therapy and the PCI. There are lots ofcontroversies over which of the method is perfect for the managementof the disease condition. This study is focused on conductingresearch on the two approaches to determine the most appropriate way.Several people have done a survey and reported on this topic, but Iwill employ current methodologies completely varied from what wasearlier used so that with the rapid changes in technology it iseasier to improve the health of the patients.

Literaturereview

Backgroundinformation

Researchand experiments have previously shown Primary percutaneous coronaryintervention (PCI) as being superior compared to fibrinolytic therapyregarding the treatment of ST-segment elevation myocardial infarction(STEMI) (Afilalo, Roy, &amp Eisenberg, 2009). Door-to-balloon is thedelay in the coronary artery that occurs between admission and realinflation of the PCI balloon in the coronary artery (Steg &ampJuliard, 2005). Door-to-door and door-to-needle also presents delaysin the coronary artery with door showing the arrival of patients tothe medical facilities (Wallace et al., 2015).

Madanet al. (2015) carried out a study that had an aim of investigatingthe link between time to invasive assessments and the outcomes of theinvasive assessment amongst patients of ST-segment evaluationmyocardial infarction. The results indicated that there was reducedrisks of death or hospital major infection or reinfection withinthirty days after fibrinolysis on patients. However, the study aswell established that it was necessary for patients who wereinitially treated with fibrinolysis to be promptly transferred to thePCI center that was nearest as it is required for the patients toundergo immediate angiography and PCI. The results of the studyconveyed that angiography at the 4-hour mark revealed an associationwith reduced 30-day inadequate blood supply to the heart. On the samenote, insufficient blood supply to the heart was increased withincreasing fibrinolysis to angiography time

Accordingto Nallamothu and Bates (2003), a delay greater than an hour has thepotential of eliminating the morality benefits that are associatedwith PCI in ST-segment elevation myocardial. On the same note, theresearch conducted by Nallamothu, Antman, and Bates (2004), revealedthat the value and advantage that is associated with PCI inST-segment is always lost when there is a delay that exceeds one hourin the door-to-needle time therapy. Fibrinolytic agents are activelyconsidered in the situations where such kinds of delays are expected.

Justification

Thelife of patients with infarction heart disease is at risk since anydelay from the Fibrinolytic approach that exceeds one hour means alife would be lost. It is, therefore, very critical for this study toclearly identify the importance of choosing the PCI over the methodsfor the sake of saving the patients` lives.

Etiology

Aheart attack thought to occur when the supply of blood which hasnutrients and oxygen fails or is cut off from reaching the myocardialmuscles is called an infarction. The supply is usually done throughthe coronary arteries. Blockage can be as a result of the developmentof a thrombus (a blood clot) which is thought to be caused as aresult of atherosclerosis.

Symptomsand risk factors

Thegeneral signs include chest pain that is considered to be squeezing,cumbersome and occasionally burning. It is accompanied by nausea,sweating, and breathlessness. Several factors tend to predisposeindividuals to the risk of developing the condition. They includeobesity, diabetes, hypertension, cigarette smoking and abnormalcholesterol levels.

Diagnosisand treatment

Inthe hospital, it is tested using an electrocardiogram, with closeobservation of the patient`s blood pressure. Some specific markers ofthe heart muscle can also be done to attest the heart’s condition.

Materialsand methods

PersonnelIwill seek a laboratory technologist, a nurse and a clinician who willhelp me to diagnose, observe and treat the patients while conductingthe study.

Studydesign itwill be a cohort study where the patients will be selected expose tothe treatment techniques and observed over a period of about fourmonths.

Studypopulation itwill include all the patients who show up at the clinic with thesigns of myocardial infarction.

Inclusioncriteria thestudy will include all the patients who are tested and diagnosedpositive for the heart infarction.

Exclusioncriteria thestudy will exclude all the individual with signs of myocardialinfarction but tests negative for the condition.

SampleSize Determination

UsingFisher’s Test to calculate sample size

N= Z2PQD

d2

N= Desired sample size

Z= Normal deviation = 1.96 that corresponds to 95% confidence

Interval

P= Proportion of the target population estimated to have desired

Characteristics0.02 = 2 %( 4)

Q= 1 – P.

d= degrees of freedom = 0.05.

D= design effect = 1.

N= 1.962x0.02 x 0.98 x 1

(0.05)2

=29 participants.

DataAnalysis and Presentation

Datawill be presented in tables and charts to represent differentmeasures of central tendencies and measures of dispersion.

Lineand bar graphs will be used for comparison of the treatment methodsconcerning the healing population and time of recovery.

EthicalConsiderations

Iwill obtain approval from the Ethics Review Committee. An informed,written and voluntary consent will be sought from the patients beforerequesting for specimens for testing. No extra costs will be chargedto the participants because of this study.

Strictconfidentiality will be maintained, and all personal identifiers willbe removed from data during analysis.

Therisks and benefits of the participants in the study will be clearlyexplained to the participants in a language they can understandduring the process of informed consent.

Thebenefits of participation in the study will include identificationand immediate treatment of myocardial infarction, confirmed andawareness on the control and prevention knowledge where necessary. Noincentives will be offered to participants for the study.

Participantswill be allowed to withdraw from the study at any time during thestudy and will not suffer any direct consequences.

Budget

VOTE HEADS

ESTIMATED COST (USD)

Expendable supplies

1. personnel

8,000

2. Reagents

3,000

Gloves

400

Local travel

3000

Documentation

Stationeries

1000

Printing cost

1000

Miscellaneous

500

Ethical review fee

2,500

Project fee

4,500

TOTAL

23,900

Timeframe

Task

Year 2016

July-August

August-September

September-October

October-December

Proposal presentation/correction/ethical review

Diagnosis and presentation of participants.

Data collection and analysis

Research write up

Report publication and presentation

References

Afilalo,J., Roy, M. A. &amp Eisenberg, M. J. (2009). A systematic review offibrinolytic-facilitated percutaneous coronary intervention:Potential benefits and future challenges. CanadianJournal of Cardiol,(25)3, 141–148.

Madan,M., Halverson, S., Di Mario, C., Tan, M., Westerhout, C.M., Cantor,W.J., Le May, M.R., Borgia. (2015). The relationship between time toinvasive assessment and clinical outcomes of patients undergoing anearly invasive strategy after fibrinolysis for st-segment elevationmyocardial infarction. JACC:Cardiovascular Interventions,(8)1, 166–174.

Nallamothu,B. K. &amp Bates, E. R. (2003). Percutaneous coronary interventionversus fibrinolytic therapy in acute myocardial infarction: is timing(almost) everything? AmericanJournal of Cardiol,(92)7, 824-826.

Nallamothu,B. K., Antman, E. M. &amp Bates, E. R. (2004). Primarypercutaneous coronary intervention versus fibrinolytic therapy inacute myocardial infarction: does the choice of fibrinolytic agentimpact on the importance of time-to-treatment? AmericanJournal of Carinal,94(6),772-774.