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

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

Effects of Cardiac Rehabilitation Program on Right Ventricular Function After Coronary Artery Bypass Graft Surgery

Background: Cardiac rehabilitation has been recognized as one of the most effective strategies for managing cardiovascular indices as well as controlling the cardiovascular risk profile, in particular after coronary artery bypass graft surgery (CABG). However, the effect of this program on right ventricular function following CABG is unclear. The aim of this study was to evaluate the impact of cardiac rehabilitation on the right ventricular (RV) function in a cohort of patients who underwent CABG. Methods: A total of 28 patients who underwent CABG and participated consecutively in an 8-week cardiac rehabilitation program at Tehran Heart Center were studied. The control group consisted of 39 patients who refused to attend cardiac rehabilitation and only received postoperative medical treatment after registration in the Cardiac Rehabilitation Clinic. Two-dimensional and Doppler echocardiography was performed to assess the RV function in both groups at the three time points of before surgery, at the end of surgery, and at the end of the rehabilitation program. Results: Significant increase of RV function parameters were observed in both rehabilitation group (RG) and control group (CG) at the end of the rehabilitation program compared with post-CABG evaluation in terms of tricuspid annular plane systolic execution (RG: 12.50 mm to 14.18 mm; CG: 13.41 mm to 14.56 mm), tricuspid annular peak systolic velocity (RG: 8.55 cm/s to 9.14 cm/s; CG: 9.03 cm/s to 9.26 cm/s), and tricuspid annular late diastolic velocity (RG: 8.93 cm/s to 9.39 cm/s; CG: 9.26 cm/s to 9.60 cm/s).The parameters of the RV function did improve in both groups, but this improvement was not associated with participation in the complete cardiac rehabilitation program. Conclusion: The RV function parameters gradually improved after CABG; this progress, however, was independent of the exercise-based cardiac rehabilitation program

Comparing the Effects of Face-to-Face and Virtual Self-Care Training Methods on Self‐Care and Quality of Life among Patients with Heart Failure: A Randomized Clinical Trial Study

Background and Objective: Heart failure is one of the most common chronic, progressive, and debilitating heart disorders, exerting a destructive effect on self-care and quality of life in these patients. The present study aimed to compare the effects of face-to-face and virtual self-care training methods on self‐care and quality of life among patients with heart failure. Materials and Methods: This three-group clinical trial study was conducted on 120 patients with heart failure admitted to Farshchian Hospital in Hamadan. The samples were selected via the available sampling method and assigned to three groups (control, virtual, and face-to-face education) using permuted block randomization. Demographic characteristics form, European Heart Failure Self-care Behaviour Scale (EHFScBs), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) were completed by self-report before the intervention. The control group received only the routine training of the clinic, while the face-to-face training group received self-care training in four one-hour group sessions, one day apart. The virtual group received the same amount of education in the form of educational clips, and two months after the intervention, the questionnaires were completed. Chi-square tests, Fisher's exact test, paired t-test, and one-way analysis of variance were used to analyze the data. Results: The results pointed out that before the intervention, there was no statistically significant difference between the demographic variables, self-care, and quality of life of patients in the three groups (P> 0.05). After the intervention, no statistically significant difference was observed between the virtual and face-to-face training groups in terms of self-care and quality of life (P>0.05). Nonetheless, self-care and quality of life were improved in these two groups compared to the control group (P˂0.05). Conclusion: Both virtual and face-to-face training methods had the same effect on self-care and quality of life. Virtual training is a great alternative to face-to-face training in the absence of necessary conditions

Designing and psychometric assessment of the moral intelligence scale for healthcare professionals

Abstract The moral intelligence of healthcare professionals in the cardiac operating room is one of the most important aspects of professional competence. However, moral intelligence is an abstract and multidimensional concept that needs to be clarified and described based on organizational culture and environment. Therefore, there is a need to design a specific scale for measuring the moral intelligence of healthcare professionals in the cardiac operating room. This study aims to design and assess the psychometric properties of a moral intelligence scale for healthcare professionals in the cardiac operating room. The present study was a mixed method study with a sequential exploratory approach. The research was conducted in 2023–2024 in Iran. The first phase data were collected from 20 healthcare professionals and were analyzed by conventional content analysis method. In the second phase, the validity and reliability of the instrument were evaluated by involving 300 healthcare professionals in the cardiac operating room. The moral intelligence of health care professionals in the cardiac operating room was defined as moral sensitivity combined with moral commitment and moral courage for the provision of quality care that respects the principles of medical ethics. After deducing the conceptual framework, the moral intelligence scale for healthcare professionals in the cardiac operating room was developed with three dimensions: “moral sensitivity,” “moral commitment,” and “moral courage.” 11 items were removed during testing to ensure content validity. Face validity was confirmed with impact scores > 1.5 for all items. A scale was developed through factor analysis with three factors that accounted for 73.04% of the observed variance. The instrument’s reliability using Cronbach’s alpha coefficient calculation was reported as 0.94 for the entire instrument. The testretest showed no statistically significant difference between the pre and post-test scores of moral intelligence (p = 0.51). The moral intelligence scale demonstrated acceptable psychometric properties. The moral intelligence scale for health care professionals in the cardiac operating room demonstrated acceptable psychometric properties. This instrument may serve to assess the moral intelligence of healthcare professionals and determine the need for educational interventions to reduce the ethical challenges and improve the moral intelligence of this healthcare

Frequency of P16IN K4a and P14ARF genes methylation and its impact on bladder cancer cases in north Indian population

Abstract. Introduction: Amongst the genitourinary cancers, carcinoma of the urinary bladder is one of the leading causes of death in India. Hypermethylation of the CpG islands of gene promoter is one of the earliest and most frequent epigenetic alterations leading to cancer as well as in its development. Several studies have suggested that tumour suppressor genes play a key role in the development of cancer. Methylation in the CDKN2A has been associated with various malignant diseases, but information with respect to urinary bladder cancer is lacking in north Indian population. Materials and methods: We analyzed the methylation of P16INK4a and P14ARF in 80 tissues and matched blood samples of patients suffering from bladder cancer and 80 blood samples of cancer-free individuals by MS-PCR. Results: In tissue and matched blood samples of bladder cancer patients, the incidence of P14ARF hypermethylation significantly increased (OR = 0.31, 95%CI = 0.12-0.8, P = 0.01) and (OR = 0.0, 95%CI = 0.0-0.62, P = 0.006) respectively with an increase in age. Clinicopathological analysis revealed that P14ARF hypermethylation in tissue and blood samples was significantly associated with invasive stage ( T2) (OR = 0.21, 95%CI = 0.08-0.51, P = 0.0002) and (OR = 0.09, 95%CI = 0.03-0.37, P = 0.00001) respectively. Muscle invasive tumour stage ( T2) showed significant association with increased risk of P16INK4α promoter hypermethylation in tissue and blood samples of patients (OR = 0.38, 95%CI = 0.17-0.82, P = 0.01) and (OR = 0.13, 95%CI = 0.05-0.36, P = 0.00005) respectively. Conclusion: These results suggest that the CpG island hypermethylation status of the defined panel of genes may be a useful biomarker in patients suffering from bladder cancer