Introduction:Patients with mechanical heart valve need anticoagulant therapy to prevent thrombotic events. The treatment interacts with some foods and drugs. The aim was to evaluate the effect of self-management program on self-efficacy and medication adherence in patients with mechanical heart valve. Methods: This was a randomized controlled trial. eighty eligible patients, with the ability to read and speak in Farsi, aged between 15 to 60, were included in the study from the cardiac surgery clinic in Imam Khomeini hospital affiliated to Tehran University of Medical Sciences (Tehran, Iran) and randomly allocated to intervention and control groups. The participants had no history of psychiatric disorders, had undergone valve replacement surgery at least one year before the study, and were being treated with Warfarin. The intervention was a combination of 2 one-hour selfmanagement education via small groups with 3 to 5 members, self-management educational booklets, and weekly call follow-ups for 8 weeks about 10-15 minutes. The control group received no intervention. Self-efficacy was the primary outcome and medication adherence, Prothrombin Time (PT), and International Normalized Ratio (INR) were secondary outcomes. Data were analyzed using SPSS13. Results: Although the mean of self-efficacy and medication adherence, PT, and INR values were not different between the two groups at baseline, they improved significantly following the program. Conclusion: Self-management program had a positive effect on self-efficacy and medication adherence of patients with mechanical heart valve.Citation: Javan L, kazemnejad K, Nomali M, Zakerimoghadam M. Effect of self-management program on self-efficacy and medication adherence in patients with mechanical heart valve: a randomized controlled trial.

Introduction: Because of the chronic nature of Heart Failure (HF), low Quality of Life (QoL) and poor self-care are prevalent among patients with HF. Thus, the aim of this study was to evaluate the effect of illness perception correction- based educational program on QoL,and self- care in patients with HF. Methods: In this randomized controlled trial, 78 eligible patients were included in the study from Rajaei Heart Center (Tehran, Iran) and randomly assigned into intervention and control group with 1:1 allocation ratio. The intervention was a combination of illness perception correction- based education program (30- minute sessions over 3 consecutive days) and 10-minute phone calls made once a week in the course of 8 weeks. The control group received usual care. The primary outcome was quality of life and secondary outcomes were self- care and illness- perception which were measured at baseline and at the end of the study. SPSS version 13 was used for the analysis. Results: Out of 76 eligible patients, 70 patients with HF finished the study. Although the mean of quality of life, self-care, and illness perception were not different at baseline, QoL (45.2 (8.3) VS 66.8 (15.4); P<0.001), self-care (18.5 (4.5) VS 37.1 (7.2); P<0.001), and illness- perception (183.6 (8.4) VS 151.2 (24.5); P<0.001) improved following the program in the intervention group in comparison to the control group. Conclusion: According to the study findings, this program can be applied by nurses for patients with HF as a discharge plan in order to improve their QoL, self-care, and their illness perception.

BackgroundPatients with ST-segment elevation myocardial infarction (STEMI) experience major adverse cardiac events (MACEs) following primary percutaneous coronary intervention (PCI). Although the relationship between time to treatment (eg, door-to-balloon time, symptom onset-to-balloon time, and symptom onset-to-door time) and 1-month all-cause mortality was assessed previously, its relationship with in-hospital MACEs and the effect of some clinical characteristics on this relationship were not considered. Furthermore, previous studies that were conducted in developed countries with a different quality of care cannot be applied in Iran, as Iran is a developing country and the studies were not performed according to the 24/7 primary PCI service registry.ObjectiveThe objective of this study protocol is to determine the relationship between time to treatment and in-hospital MACEs.MethodsThis cross-sectional study will take place at the Tehran Heart Center (THC), which is affiliated with Tehran University of Medical Sciences (TUMS) in Tehran, Iran. Data related to patients with STEMI, who underwent primary PCI between March 2015 and March 2019, that have been prospectively recorded in the THC’s 24/7 primary PCI service registry will be analyzed. The study outcome is the occurrence of in-hospital MACEs. Data analysis will be conducted using SPSS for Windows, version 16.0 (SPSS Inc). We will perform chi-square tests, independent-samples t tests, or the Mann-Whitney U test, as well as univariate and multivariate binary logistic regression with a significance level of less than .05 and 95% CI for odds ratios.ResultsFrom March 2015 to September 2017, 1586 patients were included in the THC service registry, consecutively. We will conduct a retrospective analysis of this registry on patient entries between March 2015 and March 2019 and data will be analyzed and published by the end of 2019.ConclusionsTo our knowledge, this is the first observational study based on the 24/7 primary PCI service registry in Iran. The findings of this study may reveal current problems regarding time to treatment in STEMI management in the THC. Results from this study may help determine appropriate preventive strategies that need to be applied in order to reduce time-to-treatment delays and improve patients’ outcomes following primary PCI in the setting of STEMI at the THC and similar clinical centers.International Registered Report Identifier (IRRID)DERR1-10.2196/13161

BackgroundPatients with heart failure (HF) reduced ejection fraction (HFrEF) have symptoms that are more severe and experience a higher rate of hospitalization compared with HF preserved ejection fraction (HFpEF) patients. However, symptom recognition cannot be made by patients based on current approaches. This problem is a barrier to effective self-care that needs to be improved by new self-monitoring instruments and strategies.ObjectiveThis study describes a protocol for the self-monitoring daily diaries of weight and shortness of breath (SOB) based on the traffic light system (TLS). The primary objective is to compare the self-care between the intervention and control group. Comparison of HF knowledge, HF quality of life (HFQOL), and all-cause hospitalization between the 2 groups are the secondary objectives.MethodsA single-blind randomized controlled trial is being conducted at the HF clinic at Tehran Heart Center (Tehran, Iran). Sixty-eight adult patients of both genders will be enrolled during admission to HF clinic. Eligible subjects will be assigned to either the intervention or control group by a block balanced randomization method. Baseline surveys will be conducted before random allocation. Participants in the intervention group will receive an integrated package consisting of (1) HF self-care education by an Australian Heart Foundation booklet on HF, (2) regular home self-monitoring of weight and SOB, and (3) scheduled call follow-ups for 3 months. Patients in the control group will receive no intervention and they only complete monthly surveys.ResultsThis study is ongoing and is expected to be completed by the end of 2018.ConclusionsThis is the first trial with new self-monitoring instruments in Iran as a low and middle-income country. If the findings show a positive effect, the package will be applied in different regions with the same health care status.Trial RegistrationIranian Registry of Clinical Trials IRCT2017021032476N1; https://en.irct.ir/trial/25296?revision=25296 (Archived by WebCite at http://www.webcitation.org/73DLICQL8)International Registered Report Identifier (IRRID)PRR1-10.2196/9209

No abstract

BackgroundMalnutrition occurs following a decrease or an imbalance in the absorption of energy, protein, vitamins, and minerals because of numerous factors. Thus, it has serious and life-threatening consequences. To plan for this issue, we need information on the burden of this problem.ObjectiveThe aim of this study is to determine the prevalence of malnutrition among elderly people in Iran.MethodsFor the purpose of this study, papers, including original articles, theses, and conference proceedings on the prevalence of malnutrition among people aged 60 years and above, and have been published in national and international journals until September 2018 will be included without any language limitation. The following keywords along with their synonyms in Persian will be used in the literature search: malnutrition, elderly, and Iran. At first, the screening process will be conducted based on our inclusion and exclusion criteria. Then, the full text of the remaining articles will be read carefully, and eligible articles will be selected according to the objectives of the study. Next, the methodological quality of the selected papers will be reviewed, and the required information will be extracted from those with acceptable quality. Finally, a meta-analysis will be performed using the Stata software (version 14) when optimum criteria are met. It should be noted that all stages of screening, selection, quality assessment of primary studies, and data extraction will be performed by two reviewers independently.ResultsThis review is ongoing and will be completed at the end of 2019.ConclusionsThis review aims to provide comprehensive evidence about the prevalence of malnutrition among elderly people in Iran. This can help Iranian health managers and policy makers make informed decisions for preventing malnutrition and promoting the health status of elderly people.Trial RegistrationPROSPERO CRD42018115358; https://tinyurl.com/y28su47mInternational Registered Report Identifier (IRRID)DERR1-10.2196/15334

Background: Heart failure (HF) is a serious problem with an increasing prevalence globally. Low level of HF knowledge may cause low compliance and low quality of life and, poor self-care. On the other hand, assessing the level of HF knowledge is necessary in order to apply educational programs. Aims and objectives: the aim was to determine knowledge regarding HF among Iranian patients with HF. Study Design: This was a cross sectional study. Setting: We conducted this study at the HF clinic of Tehran Heart Center (THC) affiliated with Tehran University of Medical Sciences (TUMS, Tehran, Iran). Materials and Methods: In this cross-sectional study, 190 patients older than 18 years old, with confirmed diagnosis of HF for at least 3 months by an HF specialist, NYHA function class II to IV and an ability of reading and writing Farsi language were included during June 2017 and January 2018 by consecutive sampling. Data were gathered in a short form, including demographic and clinical variables. Knowledge regarding HF was measured by the Dutch HF knowledge scale (Cronbach’s alpha=0.62) with 15- multiple choice item. The score range varied between 0 (no knowledge) and 15 (optimum knowledge). Scores were reported totally and in 3 areas of knowledge. Scores higher than the median was considered as higher knowledge. Statistics: The SPSS software version 16 was used to describe data. Normality of continuous variables was checked by the Kolmogorov-Smirnoff test. Frequency and partial frequency distribution were used to describe Categorical variables. While, we used mean, median, standard deviation, and IQR for describing continuous variables. Results: From June 2017 to January 2018, 160/190 patients with median age (IQR) of 59 (16) years old participated in the study (response rate of 84.2%). 67.5% of study patients were male (83.5%). 87.5% of then were married. The majority of patients were with NYHA function class II (60.6%), and with an etiology of ischemic heart disease (65.0%). The median and IQR of total, general, HF treatment, and symptoms/ symptom recognition knowledge were 8 (7-10), 12 (9-14), 2 (1.25-3), and 4 (3-5), respectively. Low level of total, general, HF treatment, and symptoms and symptom recognition knowledge among Iranian patients with HF were 55%, 60%, 58.8%, and 71.9%, respectively. Conclusion: Patients with HF had low levels of total, general, HF treatment, and symptoms/symptom recognition knowledge. Thus, there is an essential need to be improved by an appropriate intervention, especially on knowledge of symptoms /symptom recognition.

Background: Patients undergo Coronary Artery Bypass Graft (CABG) surgery experience varying degrees of discomfort. Few studies evaluate the effect of music on patients` comfort. Aims and objectives: The aim of this study was to determine effect of listening to music on general comfort level of patients underwent CABG surgery. Study Design: This was a randomized controlled trial. Setting: This study was conducted in open heart surgery Intensive Care Unit (OH-ICU) in Imam Khomeini Hospital affiliated to Tehran University of Medical Sciences. Materials and Methods: 65 patients with age between 30 to 75 years, stable hemodynamic condition, no substance abuse, no hearing problems and underwent CABG surgery for the first time were allocated to two groups of intervention and control by block balanced randomization method. Intervention was listening to preferred light and instrumental music for 30 minutes in day after surgery at 4 to 6 PM by MP3 player and individual headphone, while patients in the control group received usual care. Study outcome was general comfort level that was measured by general comfort questionnaire (GCQ) at baseline and at end of the study. Statistics: SPSS software version 16 was used. Data were described and analyzed by descriptive statistics and statistical tests. A P-value less than 0.05 was considered statistically significant. Results: At end of the study, 62 patients (31 patients in each group) completed the study. There is no significant difference between the two groups at baseline regarding demographic and clinical characteristic (P>0.05). Although patients` general comfort level was not different between intervention and control groups (47.10 ±2.04, and 47.10 ±1.95; P= 1.000), it improved significantly following the intervention in the intervention group compared with control group (45.48±2.01 vs 47.29±1.95; P< 0.001). Conclusion: Our study indicated that listening to preferred music can be used as a non-invasive intervention by nurses for patients underwent CABG surgery during hospitalization in order to improve their general comfort level.