Assessment of General

: Objectives: To assess the general health and physical aspect for patients undergoing Percutaneous transluminal coronary angioplasty in Baghdad city. Design: A descriptive study in which the assessment approach is applied to achieve the objectives of the study. Methodology: A descriptive study ( A purposive (non-probability)) sample of (70) patients was selected to assess the objective of the study, The study was initiated from March 15 th , 2011 until the 20 th of April, 2012. A questionnaire was designed and constructed by the researcher to easure the variables underlying the present study.The data were collected through the utilization of the developed questionnaire and by means of structured interview with the patients, the interview with each patients took approximately (15) minutes, the data collection was performed from (April 15 th , 2011 until the 20 th of November, 2011). Data were analyzed through using descriptive Statistical Data Analysis which include (Frequency, Percentage, Arithmetic mean, The standard deviation (SD)) and Inferential Statistical Data Analysis (Contingency Coefficient, Spearman rank correlation coefficient) . Results: the study indicated the most of sample male, married, read and write, self-employee and in age group (50-59) years old, suffering from diabetes, period of disease diagnosis (1-5) years, the study confirmed the most of patients had moderate level in regard general health and physical aspect of patients undergoing PCI. Recommendations: An educational program should be designed and Pamphlets or manuals should be distributed to increase patients' information about PTCA procedure to improve their quality of life.


Abstract:
Since percutaneous transluminal coronary angioplasty (PTCA) introduction by Andreas Gruntzig in 1977, percutaneous coronary intervention (PCI) has revolutionised the care for patients with coronary artery disease (CAD) , In the United States, more than one million patients are treated with percutaneous coronary intervention (2) .
Coronary artery disease affected about 16 million patients in united status at an estimated cost of 156 $ billion in 2008.More than 650,000 patients undergo percutaneous transluminal coronary angioplasty (PTCA) or stent procedures annually, representing a 324% increase in PTCA procedures between 1987 and 2002 (3) .
There are two ways of revascularization are established for coronary artery disease which include CABG, introduced in 1968, and PCI.Percutaneous coronary intervention includes percutaneous balloon angioplasty, introduced in 1977, and stenting with bare metal stents (BMSs), in use since 1995, or drug-eluting stents (DESs), in use since 2003 (4) .
Several clinical studies have shown that acute myocardial infarction (AMI) causes a decline in all patients functioning like the physical and psychological, social, These changes in health status outcome or quality of life (QOL) can impair the patient's ability to perform even basic daily tasks (5) .
This study aims to assess general health of patients and their ability to deal with some of physical aspects like: pain, discomfort, energy and work, sleep, and symptoms related to patients conditions.

METHODOLOGY:
A descriptive study in which the assessment approach is applied to assess the general health and physical aspect for patients undergoing Percutaneous transluminal coronary angioplasty (PTCA) in Baghdad city, The study was initiated from March 15 th , 2011 until the 20 th of April, 2012.
The Study was conducted on patients undergoing Percutaneous transluminal coronary angioplasty procedure were attended to outpatient clinics at three Baghdad hospitals (Iraqi center for heart disease , Ibn-Al -Bettar Hospital and Ibn-Al -Nafees Hospital ).These hospitals are considered the most appropriate settings in which the subjects for the study can be selected.
A purposive (non-probability) sample of (70) patients were selected based on the following criteria: Criteria for patient with undergoing PTCA procedure: 1-Patients undergoing PTCA procedure for at least one year ago.
2-Free from complications and target organ damage.

3-Free from other chronic illnesses except diabetes mellitus.
A questionnaire was designed and constructed by the researcher to measure the variables underlying the present study, which was consisted of four parts.
Part I: demographic Characteristics: This part was designed to measure the sample demographic characteristics, which include age, gender, marital status, level of education, occupational status.
Part II: Clinical Data: Clinical data in term of period of disease diagnosis, cost of medication, number of drugs use, regularity of drug taking, how often balloon made, presence of diabetes mellitus.
Part III: General Health Questionnaire: It was adopted from short form quality of life-36 items (SF-36) scale and consisted of two items to determine the general health of the sample and rated as (good, fair, poor) and calculated according to quartile ranging ,The higher score of the questionnaire its mean the good general health.
Part IV: physical dimension Scale: The investigator adopted and developed physical aspect scale from the quality of life world health organization scale (6) to measure the variable underlying the present study and based on (4) subdomains wich were described (Pain and discomfort (4) items; energy and fatigue (6) items; sleep (3) items; and symptoms related disease (9) items.
The items of the questionnaire were rated and scored according to the following: a-Three point likert scale is used for rating the items as always, sometimes, never . The three point type likert scale is scored as (3) for always, (2) for sometimes, (1) for never in all items.The higher score of the questionnaire means good general health and physical aspect for patients.b-Quartile, after arranging the sum of items ascending for patients answers to determine the general health and physical aspect levels (good, fair, poor) Quartile was calculated as following formula : The validity of the instrument was achieved through a panel of experts, the developed questionnaire was designed and presented to (10) experts: (7) Faculty members from the College of Nursing/ University of Baghdad, and,(1) Faculty member at the statistical department of College of the Administration and Economics/ University of Baghdad, (1) faculty member is at the Iraqi Cardiac Center in A surgical Specialist Hospital, (1) faculty members at Abn-Albitar specialized center for cardiac surgery.
The data were collected through the utilization of the developed questionnaire and by means of structured interview with the subjects, the subjects were individually interviewed in the outpatient clinics by using the Arabic version of the questionnaire, the interview with each patients took approximately (15) minutes, the data collection was performed from (April 15 th , 2011 until the 20 th of November, 2011).
Data were analyzed through the use of statistical package of social sciences (SPSS) version (16) through using descriptive Statistical Data Analysis which include( Frequency, Percentage, Arithmetic mean,The standard deviation (SD)) and Inferential Statistical Data Analysis (Contingency Coefficient, Spearman rank correlation coefficient (rs) (rho) (7) .Table (1) shows that the distribution of the patients of the study, Regarding gender, the majority of sample (70%) were male, and according to age group, the majority of patients (44.3%) were of (50-59) years old age and the mean age of patients were (47.4) years  (6.38), Regarding marital status, the highest percentage of patients (80 %) were married.

RESULTS:
Regarding level of education, the data shows that the highest percentage of patient's underging PTCA procedure (27.1%) were reading and writing.
Regarding to the occupation status the table presents that the majority of sample (38.6%) were self-employed.Table (2) reveals the clinical data of patients study, regarding to Cost of drugs payment result shows most of patients (77.1%) find that drugs mostly cost, in period of disease diagnosis the result finding that highest percentage of patients (72.9%) were at group (1-5) years and most of patients (72.8%) were taking 3-4 drugs and majority of patients (94.3%) take drugs regular and most of patients (90%) made procedure for the second time ,in regarding suffering of diabetes mellitus more than one half of patients (65.7%) suffering from diabetes mellitus.Regarding general health, the results show that most of patients (67.1%) rated as moderate level, regarding total physical aspect The results show that major study sample (45.7%) rated as moderate health level.
In addition to total physical aspect the study reveals the subdomains of physical aspect (pain, energy, sleep, symptoms), in regard that the finding show all of subdomains rated as moderate physical functioning level (44.3%),(37.1%),(51.4%),(40%)respectively, and all of them had moderate grade in mean of score except the sleep was graded as (2.52) high mean score.Table (4) reveals that there were significant relationship between general health and marital status (P=0.04), and non-significant relationship between general health and other demographic variables: gender (P= 0.30), age (P=0.09),level of education (P=0.32),occupation status (0.14) respectively.Table (5) reveals that there were non-significant relationship between general health for patients and all clinical variables: period of disease diagnosis (P= 0.15), number of drug taken (P=0.72),regularity of drug taken (P= 0.08), how often balloon made (P=0.24),diabetes mellitus(0.42)respectively.Table (7) show that there were significant relationship between total physical domain for patients and regularity of drug taken (P= 0.03), and Table reveals that there were non-significant relationship between total physical domain for patients and other all clinical variables: period of disease diagnosis (P= 0.11), number of drug taken (P=0.58),how often balloon made (P=0.16),diabetes mellitus (0.87) respectively.

Table (4): Association and Correlation between General Health for Patients with their
Table also show there is strong correlation between total physical domain for PTCA patients and diabetes mellitus (P= 0.82), number of drug taken (P=0.77),and weak correlation between total physical domain for PTCA patients and regularity of drug taken (P= 0.13), how often balloon made (P=0.11),period of disease diagnosis (P= 0.08), respectively.

DISCUSSION:
Research results shows that more than two third of study sample were male, and most of them in age group (50-59) years and married, self employee and reading and writing.(table1)this results are supported by other study which show that most of study sample were male (8) (9) (10) and mean age of sample (61.9) years (9) other studies (11) indicated that age was 59.3years,and mean age 57 years (8) and mean age 62•7 years (SD 5•7) in additional studies (10) .In regard these results, studies reveals two third (71% ) of their study Live with spouse,(38%) of study sample of their study were suffering from diabetes mellitus, inspite of their study reported that ( 78% ) of their study were completed high school (9) .The result finding that major period of disease diagnosis in patients were (1-5 years) and more than two third of study sample were taking 3-4 drugs and suffering from disease and most of them compliance in taking drug regularly.This study show majority of sample made intervention more than one time(table 2) this result is supported by other study which reveals that third of his result study had previous PCI. (8) (9)e study result in (table 3,4) is supported by other study (12) which reveals that The PTCA group had significantly greater improvements in physical functioning, vitality and general health at both three months and one year, other researcher stated that the Chest pain and shortness of breath at rest and on exertion decreased and functional and psychological status improved 3.9 months after PTCA (8) ,some of researcher reported that the QOL of the patients who had undergone CABG and PTCA was significantly better on the dimensions of energy, pain, and mobility one year after the intervention (13) .
The study reveals there significant relationship between general health and marital status and non-significant relationship between general health and other demographic variables (table 4) In addition, result reveals that there were non-significant relationship between general health for patients and all clinical variables (table 5).
Women with coronary artery disease (CAD) reported significantly poorer QOL than age-matched women in the healthy sample, as measured by the following dimensions of the: energy, sleep, pain, emotional reactions, and physical mobility.QOL for women with CAD was lower than that of men with CAD.The mean indexes of four dimensions, energy, sleep, emotional reactions, and physical mobility were higher for women with CAD than men with CAD in the two youngest age groups (14).In regard to diabetes this result supported by other study which stated that the QOL measures were similar between both patient groups diabetes and non diabetes patients at baseline (5).
Result reveals that there were non-significant relationship between total physical domain and all demographic variables (table 6).
Regarding study results in table (7), other researcher confirm that fragmented sleep is a problem partly because of psycho-physiological symptoms one year after PTCA, with reduced restlessness to stress, increasing vulnerability or diminished coping ability and poorer quality of life (10) .

CONCLUSION:
According to the present study findings, the researcher enabled to make the following conclusions: -the study indicated the most of patients were male, and married ,they can read and write, and they work as self employee and in age group (50-59) years old, suffering from diabetes and had restenosis in artery revascularization , period of disease diagnosis (1-5) years.
-the study confirmed moderate level in general health and total and sub domain of physical aspect of patients undergoing PCI.

RECOMMENDATIONS:
According to the results of the study, the researcher recommends that: 1.An educational program should be designed and performed on admissions of patients to increase their information about PTCA procedure to improve their quality of life.2. Pamphlets or manuals should be distributed to patients include information regarding management of disease by diet, energy, sleep, complication that may occur after the procedure.3. Further study should be conducted included large sample study.

Table ( 3) General health and physical domains for patients undergoing PTCA procedure.
*( moderate) / SD = standard deviation / F=Frequency / % = percentageTable(3) indicates the results of general health and physical aspect for patients undergoing PTCA procedure.

Table also
shows there is strong correlation between general health for PTCA patients and number of drug taken (P=0.92),andweak correlation between general health for PTCA patients and regularity of drug taken (P= 0.31), diabetes mellitus(P= 0.19), period of disease diagnosis (P= 0.16), how often balloon made (P=0.04)respectively.

Table ( 6): Association and Correlation between physical domain for Patients with their Demographical Variables: (P. Value) = probability Value, (Sig) significant Probability value (p < 0.05)/ df= degree of freedom /NS= non significant / S=significant
Table also show there is strong correlation between Physical domain of PTCA patients and occupation status(0.79),gender(0.72),andmoderate correlation between Physical domain of PTCA patients and level of education (0.66),and weak correlation between Physical domain of PTCA patients and marital status(0.46),age (0.12).