Advanced cardiac life support training by problem based method: effect on the trainees skills, knowledge and evaluation of trainers

Background: Cardiopulmonary-cerebral resuscitation (CPCR) training is essential for all hospital workers, especially junior residents who might become the manager of the resuscitation team. In our center, the traditional CPCR knowledge training curriculum for junior residents up to 5 years ago was lecture-based and had some faults. This study aimed to evaluate the effect of a problem-based method on residents’ CPCR knowledge and skills as well as their evaluation of their CPCR trainers. Methods: This study, conducted at Tehran University of Medical Sciences, included 290 first-year residents in 2009-2010-who were trained via a problem-based method (the problem-based group) - and 160 first-year residents in 2003-2004 - who were trained via a lecture-based method (the lecture-based group). Other educational techniques and facilities were similar. The participants self-evaluated their own CPCR knowledge and skills pre and post workshop and also assessed their trainers’ efficacy post workshop by completing special questionnaires. Results: The problem-based group, trained via the problem-based method, had higher self-assessment scores of CPCR knowledge and skills post workshop: the difference as regards the mean scores between the problem-based and lecture-based groups was 32.36 ± 19.23 vs. 22.33 ± 20.35 for knowledge (p value = 0.003) and 10.13 ± 7.17 vs. 8.19 ± 8.45 for skills (p value = 0.043). The residents’ evaluation of their trainers was similar between the two study groups (p value = 0.193), with the mean scores being 15.90 ± 2.59 and 15.46 ± 2.90 in the problem-based and lecture-based groups – respectively. Conclusion: The problem-based method increased our residents’ self-evaluation score of their own CPCR knowledge and skills

Longitudinal Machine Learning Model for Predicting Systolic Blood Pressure in Patients with Heart Failure

Objective: Systolic blood pressure (SBP) is a powerful prognostic factor in heart failure (HF) patients, which is associated with death and readmission. Therefore, control of blood pressure is an important element for managing these patients. The goal of this study was to compare the performance of classical and machine learning models for predicting SBP and identify important variables related to SBP changes over time. Methods: The information of 483 HF patients was analyzed in this retrospective cohort study. These patients were hospitalized at least twice in Farshchian Heart Center Hamadan province, the west of Iran, between October 2015 and July 2019. We applied a linear mixed-effects model (LMM) and mixed-effects least-square support vector regression (MLS-SVR) for predicting SBP. The performance of both models was assessed by mean absolute error, and root mean squared error. Results: Based on LMM results, there was a significant association between sex, body mass index (BMI), sodium, time, and history of hypertension with SBP changes over time (P-value <0.05). Also, MLS-SVR indicated that the four most important variables were history of hypertension, sodium, BMI, and triglyceride. The performance of MLS-SVR compared to LMM was better in both training and testing datasets. Conclusions: According to our results, BMI, sodium, and history of hypertension were the important variables on SBP changes in both LMM and MLS-SVR models. Also, it seems that MLS-SVR can be used as an alternative for classical longitudinal models for predicting SBP in HF patients

The Efficacy of Chronic Disease Self Management Programs and Tele-Health on Psychosocial Adjustment by Increasing Self-efficacy in Patients with CABG

AbstractAim: Coronary Artery Disease is a chronic and debilitating condition that seriously affects the lives of patients and their families. Despite advances in medical treatment, CAD is still associated with high morbidity and mortality, high hospitalization rates. It is well known that rehabilitation is an integral component of the care of people with chronic disease. Despite the expense associated with rehabilitation following chronic disease, dissatisfaction with psychosocial outcomes is common. The purpose of this study was to test the efficacy of The Chronic ِ Disease Self Management Rehabilitation Program and Telehealth in cardiac patients undergone Coronary Artery Bypass Surgery (CABGS), in order to improve, enhance and maintain their psychosocial adjustment to illness through increasing self efficacy.Method: A total of 300 patients, were recruited through Tehran Heart Center's cardiac rehabilitation clinic. They were randomly assigned to intervention group which received 6 sessions (each session 150minutes in a week) of psycho-educational intervention (N=150), or to a control group which received no intervention (N=150). The patients in both groups completed pretest measures consisting of Psychosocial Adjustment to Illness Scale (PAIS) and Cardiac Self Efficacy Questionnaire (CSEQ). Participants were reassessed 2-months and 3- months later.Results: Multiple regression analysis of the collected data, revealed that both after 2 and 3 months, by enrolling the CDSMRP and Tele-health in the intervention group, enhanced significantly Psychosocial Adjustment to Illness through enhanced self efficacy.Conclusion: The Chronic Disease Self management Rehabilitation Program and Tele-health improved the self efficacy of cardiac patients which then enhanced and maintained their Psychosocial Adjustment to Illness

The Efficacy of Chronic Disease Self Management Program and Tele- Health on Adherence by Increasing Self Efficacy in Patients with CABG

AbstractAimCoronary Artery disease as a chronic disease is the single largest killer of people in the worldwide. Despite advances in medical treatment, CAD is still associated with high morbidity, mortality, high hospitalization rates. Patients with CAD require comprehensive rehabilitation to control symptoms, slow the progressive nature of condition, decrease re hospitalization, and improve survival. To achieve these outcomes, patient adherence to prescribed medications is vital whereas Poor adherence to the long-term treatment of chronic diseases has been a growing problem and a major challenge for health care professionals. The purpose of this study was to test the efficacy of The Chronic ِ Disease Self Management Rehabilitation Programs and Tele- health in cardiac patients undergone Coronary Artery Bypass Surgery (CABGS), in order to improve, enhance and maintain their adherence by increasing the efficacy during intervention sessions.MethodA total of 300 patients, were recruited through Tehran Heart Center's cardiac rehabilitation clinic. They were randomly assigned to intervention group which received 6 sessions (each session 150 minutes in a week) of psycho-educational intervention (N=150), or to a control group which received no intervention (N=150). The patients in both groups completed pretest measures consisting of General Adherence Scale (GAS), Specific Adherence Scale (SAS) and Cardiac Self Efficacy Questionnaire (CSEQ). Participants were reassessed 2-months and 3- months later.ResultMultiple regression analysis of the collected data, revealed that both after 2 and 3 months, by enrolling the CDSMRP and Tele-health in the intervention group, enhanced significantly adherence through enhanced self efficacy.ConclusionThe CDSMRP and Tele-health, improved the self efficacy of cardiac patients which then enhanced and maintained their adherence

Cardioprotective Effects of Coenzyme Q10 Supplementation on Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Background: We assessed the potential efficacy of Coenzyme Q10 (CoQ10) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Methods: Seventy STEMI patients who presented ≤12 hours after the onset of symptoms and were scheduled for PPCI were randomly assigned to the standard treatments plus CoQ10 or placebo. In the intervention group, CoQ10, as an oral capsule at a dose of 400 mg, was loaded immediately before PPCI and continued at 200 mg twice daily for 28 days. The control group received a matching placebo, similarly. The study endpoints were the proportion of patients with complete myocardial reperfusion, defined as thrombolysis in myocardial infarction (TIMI) flow and myocardial blush grade (MBG) 3 at the end of PPCI, the proportion of patients with complete ST-segment elevation resolution (≥70%) assessed 60 minutes after PPCI, the plasma levels of creatine kinase myocardial band isoenzyme (CK-MB) and troponin I (TnI) at 12, 24, 48, and 72 hours after PPCI, and left ventricular ejection fraction (LVEF) at day 28. Results: The study groups were comparable regarding baseline clinical and procedural characteristics. The proportion of patients with TIMI flow grade 3, MBG 3, and complete ST resolution after completion of PPCI was similar between the groups. Whereas at all-time points after PPCI (12, 24, 48, and 72 hours), the plasma levels of CK-MB and TnI were significantly lower in the CoQ10 group than in the control group. Further, at day 28, CoQ10-treated patients exhibited better LVEF than placebo-treated patients, and the proportion of patients with LVEF less than 50% was lower in the intervention group than in the control group. Conclusion: Our study provided evidence that CoQ10 supplementation might reduce myocardial ischemia-reperfusion injury after PPCI and help to preserve left ventricular function. However, further studies are required to validate these results

The effects of education based on Leventhal's self-regulation model on self‐care and quality of life among patients with heart failure: A clinical trial

Background: Patients with heart failure experience poor self-care and diminished quality of life (QOL). Enhancing the well-being of these patients necessitates the implementation of innovative educational methods.Objectives: To determine the effects of education based on Leventhal's self-regulation model on self-care and QOL in patients with heart failure.Methods: This clinical trial was conducted with 100 patients hospitalized with heart failure at Farshchian Hospital in Hamadan, Iran. Subjects were selected using consecutive sampling and assigned to either an intervention group or a control group, using the randomized block permutation method. Prior to and two months after the intervention, patients completed the self-care questionnaire for heart failure patients and the Minnesota Quality of Life questionnaire. The control group received routine ward education, whereas the intervention group participated in an educational program based on the Leventhal model. Data were analyzed using the chi-square, Fisher's exact, paired t, and independent t tests.Results: The two groups were homogeneous in their characteristics. The independent t-test showed no significant difference in mean baseline self-care and QOL scores between the intervention and control groups (P > 0.05). However, after the intervention, there was a significant difference (P < 0.05), with the intervention group showing an increase in self-care and QOL compared to the control group.Conclusion: Education based on Leventhal's self-regulation model resulted in improvement in self-care and QOL in patients with heart failure. It is recommended that this model be used in the education of patients with heart failure

Clinical features, management and in-hospital outcome of ST elevation myocardial infarction (STEMI) in young adults under 40 years of age

Objectives: This study was designed to evaluate the demographic and clinical findings and in-hospital management and outcome in patients with an acute ST-segment elevation myocardial infarction (STEMI). Material and methods: By review of the Cardiovascular Tehran Heart Center Registry (CVDTHCR), 2028 patients were found to have the acute STEMI. We compared the patients’ characteristics in 109 (5.4%) subjects ≤40 and 1919 subjects > 40 years old. Results: The young patients had less diabetes, hypertension, dyslipidemia and history of MI or prior revascularization, and were more likely to be male (92.7% vs. 74%), smoker (58.7% vs. 31.7%) and have family history of CVD (50.5% vs. 23.4%). The young patients had higher prevalence of angiographically normal coronary artery (13.7% vs. 0.9%; p<0.001). The young patients were more likely to undergo percutaneous coronary intervention (38.5% vs. 18.6%), whereas coronary artery bypass grafting was more common in the old ones (p<0.001). In-hospital death was markedly different among young and old patients (0.9% and 6.1%, respectively; p<0.01). Conclusion: In STEMI population, the risk profile, clinical findings and severity of coronary disease of the young differ substantially from the elderly counterparts. Young patients with STEMI have a favorable outcome compared with that in older patients