A systematic review on clinical guidelines of home health care in heart failure patients

BACKGROUND

"Guidelines for the care of heart failure patients at home support safe and effective evidence-based practice. The aims of the present study were: [1] to identify guidelines addressing the care at home for adults with heart failure and [2] evaluate the quality of the guidelines and the extent to which they address eight components of home-based HF disease management."

METHODS

A systematic review was conducted of articles published between 1st of January 2000 to 17th of May 2021 using the databases of PubMed, Web of Science, Scopus, Embase, Cochrane, and nine specific websites for guideline development organisations. Clinical guidelines for HF patients with recommendations relevant to care provision at home were included. The results were reported according to the Preferred Reporting Items for Systematic Reviews (PRISMA-2020) criteria. The quality of included guidelines was evaluated using the Appraisal of Guidelines for Research and Evaluation-II (AGREE-II) by two authors independently. Guidelines were evaluated for their coverage of eight components of HF care at home, consisting of integration, multi-disciplinary care, continuity of care, optimized treatment, patient education, patient and partner participation, care plans with clear goals of care, self-care management and palliative care.

RESULTS

Ten HF guidelines, including two nursing-focused guidelines and eight general guidelines were extracted from 280 studies. After evaluation of quality by AGREE-II, two guidelines obtained the highest score: "NICE" and the "Adapting HF guideline for nursing care in home health care settings. Five guidelines addressed all eight components of care at home while the others had six or seven.

CONCLUSIONS

This systematic review identified ten guidelines addressing care at home for patients with HF. The highest quality guidelines most relevant to the care at home of patients with HF are the "NICE" and "Adapting HF guideline for nursing care in home health care settings" and would be most appropriate for use by home healthcare nurses.

Measuring situation awareness in health care providers: a systematic review of measurement properties using COSMIN methodology

BACKGROUND

Situation awareness (SA) is a key factor in accountability and ensuring patient safety in health care. SA is an essential element to research on human factors in healthcare. It is essential to identify valid instruments for measuring this concept and assessing how it is affected by interventions and educational methods.

METHODS

This systematic review aimed to assess the measurement properties of situation awareness instruments in health care providers' (HCP_S) using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. Four databases (Medline (through PubMed), Embase, Scopus, and Web of Science) were systematically searched. A manual search was also conducted on Google Scholar and the reference list of the included primary studies to supplement the electronic search. Studies aiming to determine the measurement properties of SA instruments or non-technical skills in HCP_S were included. The overall results for each measurement property were reported as sufficient, insufficient, inconsistent, or indeterminate, and the quality of evidence was reported as high, moderate, low, or very low.

RESULTS

A total of 25 studies and 15 instruments were included in the study. More than one measurement property was reported in some of the studies, and none of the studies presented all measurement properties. The most common measurement properties were content validity (12/25) and internal consistency (12/25). Cross-cultural validity and responsiveness were not investigated in any study. Evidence quality for the measurement properties was not high in any of the 15 instruments.

CONCLUSIONS

None of the instruments can be recommended as the most suitable instrument, and all instruments were classified as promising instruments in need of further psychometric assessment. This systematic review proves the dire need for the development and psychometric evaluation of instruments to measure SA in HCPs in clinical settings.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020147349.

IMPACT OF FRAILTY ON THE DIGNITY OF COMMUNITY-DWELLING OLDER PEOPLE

The population of people aged 60 and older is rapidly increasing in developing countries such as Iran due to declining birth rates and increased life expectancy. Old age is associated with increased risk for frailty and reduced dignity. This study investigated the impact of frailty on the dignity of older people in Tehran, Iran. This cross-sectional study was conducted on 200 individuals aged 60 years and older. Data collection relied on the Demographic Questionnaire, Frailty Index for Elders (FIFE) and the Patient Dignity Inventory (PDI). Data were analyzed with SPSS 25. The mean age of the participants was 68 (±5.05) years; 62% of the participants were at risk for frailty, and 69% had few dignity-related problems. The multiple regression results showed that frailty was significantly associated with dignity (ß = -0.571, p < 0.001). The association was significant across all the dimensions of dignity measured by the PDI. The highest predictors of frailty included dependency (ß = -0.584, p < 0.001), followed by existential distress (ß = -0.560, p < 0.001), symptom distress (ß = -0.400, p = 0.400), social support (ß = -0.391, p < 0.001), and peace of mind (ß = -0.338, p < 0.001) in dignity. The results show that higher levels of frailty in older people are associated with decreases in their dignity, and frailty was the leading predictor of dignity. Providers should develop programs to prevent and reduce frailty in those at risk and to enhance the dignity of the already frail.

Situation awareness in intensive care unit nurses: A qualitative directed content analysis

Background

Situation awareness (SA) is an essential cognitive construct to create positive patient safety outcomes. SA of the nurses in the intensive care unit (ICU), where conditions may change rapidly, is particularly important. The present study aimed to explain the perception and experience of SA in ICU nurses based on Endsley's SA model.

Materials and methods

This qualitative directed content analysis was conducted on nurses in six hospitals in Tehran, Iran, from December 2020 to July 2021. Twenty-seven ICU nurses were selected using purposive sampling. Data were collected by semi-structured interviews and field observations. The data were analyzed based on the Elo and Kyngas method modified by Assarroudi et al. COREQ checklist was used to report the research.

Results

The concept of SA in ICU nurses, based on Endsley's model, includes perception of patients' clinical cues, perception of the human environment, perception of the physical environment, and perception of the organizational environment as generic categories of the perception of the elements in the environment. SA in ICU nurses also includes the main categories of comprehension the current situation through a sense of salience and interpretation of cues and projection the future situation through the prediction of patient status into the near future and environmental foresight.

Conclusion

Findings have further developed the concept of SA in ICU nurses based on Endsley's SA model. The insights and knowledge gained from this study can be useful for future practice, education, and research on SA among ICU nurses.

Development and Psychometric Evaluation of the Elderly Dignity Questionnaire

Introduction: Respect for dignity is the core of nursing. Dignity assessment improves nurses’ understanding of the level of people’s need for it. Yet, there is no valid and reliable culturally-appropriate instrument for dignity assessment among elderly people in Iran. This study aimed to develop and evaluate the psychometric properties of the Elderly Dignity Questionnaire (EDQ).

Methods: The methodological study, EDQ items were generated based on the results of a qualitative study with conventional content analysis approach into dignity and the existing literature. For qualitative and quantitative face and content validity assessments, ten experts rated item then, item impact score and content validity ratio and index were calculated. Construct validity of EDQ was assessed via the exploratory factor analysis and using the data collected from 200 elderly people. Criterion validity was tested using the Rosenberg’s Self-Esteem Scale. Reliability testing was performed via the internal consistency and the test-retest stability assessments and data was collected from twenty elderly. Data were analyzed using SPSS software version 13.

Results: Factor analysis loaded the forty items on six factors. factor six was combined with factor five due to its limited number of items. The five factors were labeled as roles and responsibilities (twelve items), familial and social relationships (seven items), self-dignity (ten items), authorization (four items), independence, and integrity (seven items). The Cronbach’s alpha and the intraclass correlation coefficient of EDQ were 0.91 and 0.86, respectively.

Conclusion: This study confirms EDQ’s validity and reliability. Thus, this questionnaire can be used for dignity in the elderly.

The experiences of home care team members regarding the needs of family caregivers of heart failure patients in home health care services in Iran: A qualitative study

BACKGROUND

Home healthcare guidelines emphasize the engagement of family caregivers of heart failure (HF) patients in patient care at home. Thus, this study was conducted with the aim to explore the deep experiences of home care team members regarding the needs of family caregivers of HF patients in home healthcare services in Iran.

METHODS

The present qualitative study was performed with a conventional content analysis approach. Data were collected through in-depth, semi-structured interviews with 23 participants who were recruited through purposive sampling. The Data were analyzed using the Graneheim and Lundman method for conventional content analysis in MAXQDA Software.

RESULTS

The participants included 14 women and 9 men with the mean age of 46.21 ± 11.44 years. After analyzing the interviews, 3 main categories and 15 subcategories were extracted. The main categories were "family caregiver's unmet needs" (with 5 subcategories), "Empowering Informal Caregivers" (with 3 subcategories), and "access to a standard home healthcare system" (with 7 subcategories).

CONCLUSION

Deep understanding of the needs of family caregivers of HF patients in home health care services increases the quality of services, the quality of life (QOL) of the family, and prevents patients' hospital readmissions. Moreover, it will contribute to our next project of the home healthcare guideline for HF patients in the health care system of Iran. Identifying the training needs of caregivers within the home health care services has an important role in the designing of education strategies in policy making programs at the level of the Ministry of Health or planning at lower levels of the health network.

The association between frailty and dignity in community-dwelling older people

BACKGROUND

The population of people aged 60 and older is rapidly increasing in developing countries such as Iran due to declining birth rates and increased life expectancy. Old age is associated with increased risk for frailty and reduced dignity. Frailty is a clinical syndrome characterized by depletion of physical reserves and multiple system disorders, reducing the individual's ability to cope with stressful events. Dignity is an inherent characteristic of human beings and respecting dignity is an ethical principle. This study investigated the association of frailty with dignity among older people in Tehran, Iran.

METHODS

This correlational study was conducted on 200 individuals aged 60 years and older. Data collection relied on the Demographic Questionnaire, Frailty Index for Elders (FIFE) and the Patient Dignity Inventory (PDI). Data were analyzed with SPSS 25.

RESULTS

The mean age of the participants was 68 ± 5.05 years; 62% of the participants were at risk for frailty, and 69% had few dignity-related problems. The multiple regression results showed that frailty was significantly associated with dignity (ß = 0.571, p < 0.001). The association was significant across all the dimensions of dignity measured by the PDI. The highest predictors of frailty included dependency (ß = 0.584, p < 0.001), followed by existential distress (ß = 0.560, p < 0.001), symptom distress (ß = 0.400, p = 0.400), social support (ß = 0.391, p < 0.001), and peace of mind (ß = 0.338, p < 0.001) in dignity.

CONCLUSIONS

The results show that higher levels of frailty in older people are associated with decreases in their dignity, and frailty was the leading predictor of dignity. Providers should develop programs to prevent and reduce frailty in those at risk and to enhance the dignity of the already frail.

Predicting ankle joint syndesmotic screw lifetime using finite element and fatigue analysis

After recovery and loading on the patient’s leg, syndesmotic screws mounted on an injured ankle may fail. The main subject of this study is to estimate the lifetime of screws considering the patient’s weight and physical activity. Method: A 3D finite element model of the bone and implemented screws were provided assigning the mechanical properties of ligaments, bones, and screws. Considering axial and tangential physiological loads during the walking phase, the stress and fatigue analyses were performed. Results: The stress distribution had an identical pattern in the screws and all of them experienced the maximum stress during 60–70% of the walking phase. Conclusion: The results of analyses show that body weight has a significant effect on the mounted screw lifetime. Patients with a weight of more than [Formula: see text] kg should prevent applying body load on the operated leg. Conversely, no worry about a patient having less than [Formula: see text] kg body weight.

Investigation of antibacterial, antifungal, antibiofilm, antioxidant and anticancer properties of methanol extracts of Salvia marashica İlçim, Celep & Doğan and Salvia caespitosa Montbret & Aucher ex Benth plants with medicinal importance

In this study, Antimicrobial, Antifungal and Antibiofilm activity tests on 16 bacteria and 2 fungi of Salvia marashica İlçim, Celep & Doğan and Salvia caespitosa Montbret & Aucher ex Benth species were performed by Agar Well Diffusion and Microdilution methods. Salvia species showed sensitivity with a zone diameter of 12-16 mm. Concentrations of 0.5 mg/ml to 16 mg/ml by the dilution method were used to determine the Minimum inhibited concentration (MIC) and Minimum bactericidal concentration (MBK). The MIC values of the plants are mostly 0.5 mg/ml - 4 mg/ml and MBC values are between 0.5 mg/ml - 8 mg/ml. Antifungal activity findings are remarkable on the species and it has been observed to have very high effects especially on Candida parapsilosis. When the antioxidant research findings are examined; It was observed that Salvia marashica and Salvia caespitosa plants have approximately 75% antioxidant activity at 1 mg/ml, and findings mostly directly proportional between concentrations and antioxidant activity capacity were recorded. MCF-7 and HUVEC cell lines were used to investigate anticancer activity properties. In line with the findings, while the IC50 value of Salvia marashica on the MCF-7 Cell line was 0.125 mg/ml, it was 1.65 mg/ml in the HUVEC cell line, while the IC50 value of Salvia caespitosa on the MCF-7 Cell line was 0.115 mg/ml in the HUVEC Cell line. It was found to be 9.87 mg/ml. It has been proven that both Salvia species have a cytotoxic effect on the MCF-7 Cell line.

Properties and Recent Advantages of N,N’-dialkylimidazolium-ion Liquids Application in Electrochemistry

:

N,Nʹ-dialkylimidazolium-ion liquids is one of the important ionic liquids with a wide range of application as conductive electrolyte and in electrochemistry. The modified electrodes create a new view in fabrication of electroanalytical sensors. Many modifiers have beeen suggested for modification of electroanalytical sensor since many years ago. Over these years, ionic liquids and especially room temperature ionic liquids have attracted more attention due to their wide range of electrochemical windows and high electrical conductivity. N,Nʹ-dialkylimidazolium-ion liquids are one of the main important ionic liquids suggested for modification of bare electrodes and especially carbon paste electrodes. Although many review articles have reported onthe use of ionic liquids in electrochemical sensors, no review article has been specifically introduced so far on the review of the advantages of N,Nʹ-dialkylimidazolium ionic liquid. Therefore, in this review paper we focused on the introduction of recent advantages of N,Nʹ-dialkyl imidazolium ionic liquid in electrochemistry.

Incidence of Myocardial Infarction (MI) in Diabetic Women and Clinical information: A study in Southwestern Iran

Introduction: Diabetes is one of the leading causes of death in the world. Due to the fact that diabetes can be one of the causes of heart attack in diabetic patients, so this was done to determine the incidence of heart attack and its related factors in these people. Materials and Methods: The present study is a retrospective cross-sectional descriptive study whose information was extracted from the records of women with diabetes referred to public hospitals in Behbahan by reading. Then the data were entered into SPSS software version 19. And were analyzed using descriptive statistics tests and analytical tests with a significance level of P <0.05. Results: The present study included 1642 diabetic women with a mean age of 54.16 73 73.16 years. Mean BMI in these patients 31.24 ± 1.46, in this study, 248 (15.1%) diabetic women had a history of myocardial infarction after diabetes. Also, the relationship between BMI and history of myocardial infarction was significant (p = 0.09), so that patients with higher BMI had a higher history of myocardial infarction. Conclusion: The results of this study showed that the relationship between myocardial infarction history and job type, BMI and type of diabetes was significant in diabetic women. Therefore, it is better for the hospital staff to train diabetic patients to control blood sugar, reduce BMI, as well as reduce smoking and drug use to reduce the risk of heart attack.

Factors Related to the Dignity of Older People in Tehran in 2020

The elderly are the fastest growing segment of the population globally. This is also the case in developing countries such as Iran. The fear of aging and the refusal to accept older adults into the mainstream of society affects the dignity of older people. This study was conducted to describe factors and dignity of older people in Tehran, Iran. This descriptive, correlational study was conducted on a sample of 215 older people above age 60 in 10 public parks in five regions of Tehran in 2020. A socio-demographic questionnaire and patient dignity inventory were used for data collection. Content validity and Cronbach’s alpha were used for evaluating the validity and reliability of questionnaires. Data were analyzed with SPSS. 60% of subjects were male and 40% female with a mean age of 68(± 5.05) year. The mean scores for dignity domains ranged from 67.30 (±17.56) for symptom distress, to 93.01(± 10.90) for dependency on a 100-point scale. The scores of dignity domains were significantly associated with job status, housing status, income source, health insurance, chronic diseases, annual physician referral rates, and hospitalization in last year. The best predictors of dignity were health insurance and annual physician referral rates. The findings of this study showed that the dignity of older people is related to a number of factors. Monitoring modifiable factors such as health insurance and annual physician referral rates and non-modifiable factors such as chronic diseases will help us to preserve or improve the dignity of older people.

Carbon Nanotubes for Amplification of Electrochemical Signal in Drug and Food Analysis; A Mini Review

Background:

Electrochemical sensors are widely used for the determination of drugs and food compounds. In recent years, the amplification of electrochemical signals with nanomaterials, especially Carbon Nanotubes (CNTs) has created a major revolution in electrochemistry.

Objective:

The present mini-review paper focused on studying the role of CNTs as conductive mediators for the fabrication of highly sensitive electrochemical sensors. CNTs, with high conductivity and good ability for modification with other materials, are interesting candidates for improving the sensitivity of electrochemical sensors. CNTs or their derivatives are suggested for different applications in electrochemistry and especially analytical biosensors. This review is aimed to discuss the conductivity feature of CNTs in electrochemical sensors.

The Concept of Successful Aging: A Review Article

Background

With the increasing number of elderly people in the world, usage of concepts and terminology related to this phenomenon has substantially increased. One concept in this context is successful aging. The purpose of the present study is to extract and introduce a common concept to be used in studies on measuring successful aging.

Methods

This is a review study. First, by searching the databases of Magiran, Noormags, Medlib, Irandoc, Iranmedex, Barakat Knowledge Network System, Civilica, SID, ISI Web Of Science, PubMed, Scopus, Science Direct and search engines, Google Scholar and Elmnet as well as using standard keywords such as elder, elderly, aging, and successful aging, all related published articles during the period 1995 to 2017 were retrieved. A total of 3417 documents were retrieved. By removing 3390 unrelated, duplicate and unusable documents, 27 articles were included in the study after quality control.

Results

The findings of the study were categorized in three areas: “defining successful aging by focusing on dimensions”, “successful aging principles” and “factors influencing successful aging”. Reviewing various studies, we found that the definition of successful aging deals with cognitive action, perception, control, life satisfaction, and ethics. Successful aging is also defined as having inner feelings of happiness and satisfaction with life for the present and the past. Sometimes successful aging is also considered to be survival with health.

Conclusion

Health care professionals as community health supporters can use the results from the present study for providing the grounds for successful aging. Then, they can use the designed successful aging program for preserving and promoting active and healthy aging for every elderly person in old age.

Echocardiographic assessment of myocardial infarction: comparison of a rat model in two strains

The purpose of this study was to induce myocardial infarction (MI) and compare the echocardiographic parameters and mortality ratio of Lewis inbred and Wistar outbred strain before and after the procedure to help choose the best one for MI studies. In this study MI was induced in 46 Lewis and 34 Wistar by occlusion of left anterior descending artery (LAD). Doppler, two-dimensional (2-D) and 2-D guided M-mode images were recorded from parasternal long-axis and parasternal short-axis and apical four-chamber views. The following parameters were acquired. Interventricular septum diastolic and systolic dimension (IVSd, s), diastolic and systolic left ventricular internal diameter (LVIDd, s), diastolic and systolic left ventricular posterior wall dimension (LVPWd, s), ejection fraction (EF), and fractional shortening (FS). The significant changes were observed in systolic IVS, LVID and EF and FS before and after MI and no significant difference was detected between Lewis and Wistar. The high mortality rate of 51% was seen in the procedure, including anesthesia in Lewis compared to 34% in Wistar. As a conclusion the echocardiographic parameters of these two strains were similar, but according to mortality rate and more cardiac anatomic variation in Lewis rats, Wistar is better for MI studies.

Exploring the religious and spiritual coping experience of cases via cancer: A qualitative research

Objective: Lately, the spiritual and religious (S/R) aspect of health behave has been receiving an increased attention in the scientific literature. The study aims to show the components of R/ S coping in cases of cancer in Iran. Method: The design of the current research is according to a qualitative research using content analysis. Sixteen patients with various kinds of cancer take part in the research. Data was produced though in-depth discussions and the gratified investigation utilized to discover categories and sub-themes. Results: Three categories combined from the information investigation: 1) Maintaining/ improving self-esteem, 2) Positive appraisal/ Being optimistic, and 3) Self-sustaining. In the participants' view, the general category realized to be the "improving calmness". Conclusions: Positive R/S coping strategies were used by the patients and most cancer patients tried to achieve calmness through R/ S coping. The findings of the research can be used to plan medical and nursing approach towards increasing the R/S quality care both in the acute and the long-term settings.

A clinical trial comparing the effect of peer education and orientation program on the anxiety levels of pre-CABG surgery patients

Background and Objectives: One of the main treatment methods of coronary artery disease is coronary artery bypass graft (CABG) surgery. The anxiety level in patients undergoing this surgery is relatively very high. Thus, reducing anxiety in these patients is an important step toward wellness. This study aimed to compare the effects of peer education (PE) and orientation program (OP) on the anxiety levels of patients before CABG surgery. Material and Methods:This randomized controlled trial was conducted in 2014 at the Mazandaran Heart Center on three groups of 50 persons each: PE, OP, and control (Cl). The anxiety levels of patients in each group were measured one day and one hour before the surgery. All groups received routine education. In addition, the PE group received PE and the OP group received OP. Two questionnaires were used to collect the demographics and the clinical data; and Spielberg state anxiety questionnaire was used to measure the anxiety level. Data from descriptive statistics, chi-square, ANOVA, ANCOVA, Bonferroni, and Fisher exact test were analyzed in SPSS v20 software. Findings: The mean anxiety score before surgery was not significantly different in the three groups (P=0.955). However, after the intervention at 1 h before surgery, the mean anxiety level in the PE and OP group was lower than in the Cl group (P=0.000). However, the mean anxiety score between PE and OP groups showed no significant difference (P=0.051). Conclusion: Both PE and OP group reduced the anxiety naturally developed in a patient before surgery. Although the influence of the PE group was greater in reducing anxiety, the use of this technique in clinical practices required further studies.

Leptin gene G-2548A polymorphism in Iranian subjects with metabolic syndrome

BACKGROUND

Metabolic syndrome (MetS) is a serious public health problem and one of the important risk factors contributing to cardiovascular disease in developed countries. Adipose tissue is considered a secretory organ that releases a variety of molecules referred to adipocytokines such as leptin, so polymorphism of these protein genes may play an important role in development of MetS. Therefore, the aim of this study was to determine the genetic varieties of Lep-2548G/A between MetS and healthy subjects.

METHODS

In this case-control study, the relationship between LEP G-2548A polymorphism and MetS was evaluated in Iranian participants, 200 patients (142 women and 58 men) and 200 controls (122 women and 78 men) who were randomly selected from Hamadan city. Blood samples were collected; moreover, routine biochemical analysis, DNA extraction, and serum leptin measurements were done. LEP G-2548A genotypes were identified by a PCR-RFLP technique.

RESULTS

Our findings showed significant differences between biochemical factors and leptin concentration between two groups. Females show more serum leptin concentration than males. There was no significant difference in polymorphism of Lep-2548G/A between MetS and healthy subjects. Although we cannot find any correlation between leptin concentration and BMI, some relation exists with LDL-C, HDL-C and TG (p < 0.05).

CONCLUSIONS

In summary, it is concluded that leptin probably has a key role in metabolic syndrome development and further research in this area is needed.

Incidence of leptospirosis in Mazandaran Province, north of Iran: a one year survey

The aim of this study was to provide the first report of incidence of leptospirosis and to determine the epidemiology of this zoonotic disease in Mazandaran Province, North of Iran. In the period of one year, from April 2007 to April 2008, forty seven confirmed reports of human cases of leptospirosis was received by Mazandaran Health Centre from local hospitals and leptospirosis laboratory. The annual incidence rate for the total population was 1.6 per 100,000 person-year. The majority of cases were males (84.1%). The maximum number of cases was seen to occur between 40 and 59 years of age. Seasonal outbreak of leptospirosis was seen in summer (70.3%). Farmers (57.4%) more frequently affected by disease than other occupations. In conclusion, it is necessary for medical practitioner to pay attention to leptospirosis in farmers during summer season.