Barriers and facilitators of readiness for hospital discharge in patients with myocardial infarction: a qualitative study: quality improvement study

Background

Readiness for hospital discharge (RHD) in patients with myocardial infarction (MI) is a key concept in the discharge process. This study was conducted to explain the barriers and facilitators of preparation for discharge in patients with MI.

Materials and methods

A qualitative study was conducted using conventional content analysis from April 2021 to 2022. Data collection was done in a targeted manner through semi-structured interviews until the data saturation stage. Nineteen participants (11 patients, 3 family members, and 5 healthcare team) were interviewed. Data analysis was done in eight steps according to the suggested steps of Graneheim and Lundman. MAXQDA18 software was used for coding.

Results

From the interviews, 348 primary codes, 11 sub-categories, and 5 categories were extracted. Finally, after continuous analysis and comparison of interviews, codes, and categories, two themes including "supporting platform" and "caring atmosphere" were extracted, which were the result of the participants' experience and understanding of the barriers and facilitators of RHD. The supporting platform included "family support" and "social support" and the caring atmosphere included "care gaps" and "professional healthcare team performance".

Conclusion

The results of this study indicate several factors affecting RHD in heart attack patients. According to the results of the study, the participation of the patient, family, healthcare team, and community in creating RHD is recommended. It is also suggested to pay attention to these factors in care and treatment planning to help improve health and control complications and prevent re-hospitalization in these patients.

Damask Rose Aromatherapy and the Anxiety of Endoscopic Candidate Patients: A Clinical Trial

Introduction: Anxiety is one of the common problems among patients before undergoing invasive diagnostic techniques. One of these diagnostic techniques is gastrointestinal endoscopy. Aromatherapy is one of the complementary therapies to reduce anxiety. Objective: This study aimed to determine the effect of aromatherapy with Damask rose on the anxiety of the patients before undergoing endoscopy. Materials and methods: This study is a clinical trial performed on patients referred to the Endoscopy Department of one of the educational and therapeutic centers in Rasht City, Iran, in 2019. The study sample was 70 patients divided into the intervention and control groups. After giving the informed consent form, the samples completed the demographic information questionnaire and Spielberger anxiety questionnaire. The intervention group received aromatherapy with 10% Damask rose essential oil, and the control group received aromatherapy with a placebo for 30 minutes. The anxiety questionnaire was completed again 30 minutes after aromatherapy. The data were analyzed using descriptive and inferential statistics (the paired t test, Chi-square, independent t test, and covariance test). Results: Results showed that the mean ± SD age of participants was 41.05 ±13.15 years in the intervention (ranged 22-65 years) and 45.82 ±16.81 years in the control groups. Most participants were female (57.1%). After the intervention, the mean score of anxiety in the aromatherapy group (39.88±11.51) was lower than that in the control group with placebo (49.94±12.30), which was statistically significant (P=0.001). Because of significant differences in hospitalization history between the two study groups before the intervention, the covariance test was performed. The results showed no interaction between aromatherapy and hospitalization history. So it seems that the hospitalization variable did not affect post-intervention anxiety. Conclusions: This study showed that aromatherapy with Damask rose essential oil was effective on pre-endoscopic anxiety of the patients. Since complementary medicine is increasingly practiced in nursing care, Damask rose aromatherapy, because of its low cost, safety and simplicity, can be used as a complementary measure to reduce anxiety in patients before endoscopy. However, more studies with intervention, control, and routine groups are needed to confirm the effectiveness of aromatherapy in endoscopy.

Detection and differentiation of opportunistic viral infections potentially contributing to renal graft rejection by tetraplex-nested PCR

The need for an intensive care protocol, sometimes weekly or biweekly, has led to a significant increase in laboratory costs for kidney recipients. In the present study, an inhouse tetraplex nested PCR assay was developed and validated for the specific detection of BKV, JCV, HCMV and EBV in clinical samples. We determined the Limit of Detection (LOD) and analytical specificity. To demonstrate the diagnostic performance of the assay, a total of 102 archival plasma samples were tested and compared with a commercial uniplex real-time PCR kits. The analytical sensitivity of the in-house tetraplex nested PCR assay was 173 copies/ml, when all four viruses were present in the specimens. These values were 79.2, 58.7, 87.6 and 96.1 copies/ml when only, BKV, JCV, HCMV and EBV respectively, were present. The cross-reactivity assays were shown no detectable signal in the tetraplex PCR results. The estimated diagnostic sensitivities were 92.6% for BKV, 92.3% for JCV and 100% for both HCMV and EBV as compared with commercial kits. Regarding the sensitivity and specificity, it seems that the developed Multiplex Nested PCR assay could be used as a reliable virusassociated renal rejection (VRR) panel in post renal transplant surveillance.

Epidemiology and prevention of drowning in Iran

Background:

Methods:

Results:

Conclusions:

Keywords:

Microsurgical anatomy of the superior and recurrent laryngeal nerves

OBJECTIVE

To study the microsurgical anatomy of the superior laryngeal nerve (SLN) and recurrent laryngeal nerve (RLN) with respect to anatomic landmarks, and to identify their vascular supplies.

METHODS

The microsurgical anatomy of the anterior neck, the course of the right and left SLN and RLN and their variations were studied in 21 cadavers. Fresh cadavers were perfused with colored silicon dye to investigate the microvasculature in detail.

RESULTS

SLN originates from the inferior vagal ganglion at the C2 level and descends medially toward the thyrohyoid membrane. It branches into an external and an internal branch deep to the internal carotid artery at the C3 level. The external branch, along with the cricothyroid artery, descends deep to the superior thyroid artery toward the cricothyroid muscle. Accompanied by the superior laryngeal artery, the internal branch passes deep to the loop of the superior thyroid artery and pierces the thyrohyoid membrane. Both nerves reside in the fascia covering longus colli muscles and are supplied by their accompanying arteries. The loop of RLN is found at the T1-T3 level on the right, and more caudally at the T3-T6 level on the left, entering the larynx between C5-C7 levels on both sides. RLN receives arterial supply from the esophageal and tracheal branches of the inferior thyroid artery proximally, and by the inferior laryngeal artery distally.

CONCLUSION

Incidental intraoperative injury to the SLN and RLN potentially could be avoided by understanding the detailed course of each nerve with respect to the surrounding anatomic landmarks and by recognizing their blood supplies.