Signs and symptoms of covid - 19 in patients with a history of coronary artery bypass grafting surgery

BACKGROUND

People who have coronary artery disease are more likely to develop signs and symptoms of COVID-19 due to their special circumstances. Coronary artery bypass grafting surgery (CABG)does not cure the disease but reduces the signs and symptoms, therefore, there is a possibility of severe complications of Covid-19 after it.

MATERIALS AND METHODS

This study is a descriptive and cross-sectional study conducted from June to July 2020 on 200 patients who underwent CABG from February 2018 to February 2020. The instrument consisted of socio-demographic variables and COVID's signs and symptoms checklist. Data were collected by census method by telephone. Data were analyzed using descriptive statistics, Fisher's exact test, Mann Whitney U test, and logistic regression model.

RESULTS

The results showed that the majority of the samples were male (67%). The mean age of them was 62.02 ± 9.06 years and 10% of the m had signs and symptoms of Covid 19. Having the symptoms of COVID-19 is significant in terms of the variables of decreased sense of smell (p < 0.002), decreased sense of taste (p < 0.002), and home quarantine (p < 0.01). The logistic regression model showed decreased sense of taste (OR = 6.071, CI95%: 1.621-29.984, p < 0.009) and non-compliance with home quarantine (OR = 0.061, CI95%: 0.005-0.741, p < 0.028) were the related variables to signs and symptoms of Covid 19.

CONCLUSION

The results did not indicate the frequency of COVID signs and symptoms among people with a history of Coronary artery bypass grafting surgery more than healthy people in the Iranian community. Extensive studies are suggested in this regard.

Death Anxiety and Related Factors Among Iranian Critical Care Nurses: A Multicenter Cross-Sectional Study

The aim of this study is to investigate death anxiety (DA) and related factors among critical care nurses. Using a cross-sectional research design, 325 critical care nurses in eight hospitals in Iran enrolled in the study. Multiple logistic regression analysis showed that deputy head nurse (OR = 18.299; CI: 1.764-189.817; p = .015), shift morning fixed (OR = 8.061; CI: 1.503-43.243; p = .015), surviving parents (OR = 3.281; CI: 1.072-10.037; p = .037), number of children (OR = 1.866; CI: 1.157-3.010; p = .011), years of working experience (OR = 1.143; CI: 1.048-1.246; p = .003), number of end-of-life patient care in the last 3 months (OR = .900; CI: .828-0.977; p = .012), age (OR = .809; CI: .732-.893; p < .001), CCU nurses (OR = .250; CI: .100-.628; p = .003), and mild stressful life events (SLEs) (OR = .167; CI: .046-.611; p = .007) were significantly related to high DA. Therefore, nurse managers and policymakers should pay special attention to these related factors in developing programs to maintain and promote the health of critical care nurses to improve the quality of nursing care.

Investigate the relationship between obstructive sleep apnea and cardiac arrhythmia after CABG surgery

BACKGROUND AND OBJECTIVE

Heart rhythm disorder is one of the most common problems after coronary artery bypass graft surgery. Various factors, such as the history of sleep apnoea before the operation, may aggravate the occurrence of this disorder. The present study was conducted to determine the relationship between sleep apnoea before surgery and heart rhythm disorder after surgery in patients undergoing coronary Artery Bypass Grafting in 2019.

METHODS

This analytical cross-sectional study was conducted on 192 patients who were selected by sequential sampling. The research tool included demographic information, a checklist of heart rhythm disorders, and the Berlin sleep apnoea questionnaire. Descriptive statistics and the Chi-square test, Fisher's exact test, Mann-Whitney's U-test, and logistic regression were used to analyze the data.

RESULTS

A total of 71.35% of the samples were male, and the mean age of the participants was 57.8 ± 7.5 years. Also, 46.0% of the samples had sleep pane and 21.35% had rhythm disorder. The most frequent heart rhythm disorder in patients with obstructive sleep apnoea was atrial fibrillation. There was a significant relationship between the occurrence of rhythm disorder and a history of smoking (P = 0.021), and the regression model showed that a history of smoking is the only variable related to the occurrence of rhythm disorder after coronary Artery Bypass Grafting (P = 0.005, CI 95%: 6.566-1.386, OR = 3.017).

CONCLUSIONS

The results showed that there is no statistically significant relationship between sleep apnea and rhythm disorder after coronary artery bypass surgery.

Comparison of Nurses' and Patients' Readiness for Hospital Discharge: A Multicenter Study

Decision to discharge is often based solely on clinical criteria but readiness for discharge is multifactorial and perceived differently by patients, families, nurses, and physicians. This is an analytical cross-sectional study aimed to compare perceptions of readiness to discharge 452 patients and their assigned nurses on the day of hospital discharge. To compare perceptions of readiness to discharge patients and their assigned nurses on the day of hospital discharge via readiness for hospital discharge (RHD) self-reported questionnaire. The biggest difference between nurses and patients’ perception scores was in the knowledge subscale. The results of linear regression model showed that patients’ gender, education, occupation, ward, nurse’s age, and marital status predict the difference between nurses and patients’ perception of readiness. Hospitalization in ear, nose, and throat (ENT) department with increasing difference and the older age of nurses is associated with a decrease in the difference between the perception. Assessment of nurse’s self-readiness can help with the development of care and education planning tailored to patients’ needs before discharge.

Risk of Falling after Coronary Artery Bypass Grafting Surgery And its Related Factors

Introduction: A fall is a sudden descent on the ground or other lower levels. It is a serious safety threat for hospitalized patients. Coronary artery bypass graft (CABG) surgery as an open heart surgery has complications such as cardiac arrhythmias and delirium that can increase the risk of fall. Objective: This study aims to determine the risk of falls in patients after CABG surgery and investigate its associated factors. Matetials and Methods: This cross-sectional study was conducted on 302 patients undergoing CABG surgery in a specialized hospital in Rasht City, Iran, from November 2019 to July 2020. They were selected by a sequential sampling method. The data collection instrument included demographic information, disease-related factors, surgery-related factors (before, during, after), and the Morse fall scale (MFS) checklist. The study data were collected after the patient's surgery and transfer from the intensive care unit to the surgical ward. Descriptive statistics, as well as the Kolmogorov Smirnov, Wilcoxon, Mann-Whitney U, Kruskal-Wallis, and Spearman correlation, were used to analyze the collected data. A rank regression model was used to determine the factors related to the risk of falls in patients. Results: The mean ±SD age of participants was 59.35 ±8.37 years. About 70.53% of the patients were male, and 46.03% were overweight (Body Mass Index ranged 25-29.9 kg/m2). The majority of patients at the time of admission to the surgical ward and before surgery (92.72%) had no risk of falls. After surgery and transfer to the surgical ward, 82.12% had a low risk of falls. The mean risk of falling was higher in patients over 60 years (P <0.05). With decreasing hemoglobin values on the morning of surgery, the risk of postoperative fall increased (P = 0.046, r = -0.115). The sodium level on the morning of surgery had a significant negative correlation (P = 0.040, r = -0.118) with the risk of falling, but urea level on the morning of surgery had a significant positive correlation (P = 0.001, r = 0.212) with the risk of falling. Using regression model, the results showed that with increasing age (B = 0.23, 95%CI; 0.07-0.39, P = 0.003), history of high blood pressure (B= 3.5, 95%CI: -0.69-0.39, P = 0.003), decrease in hemoglobin (B = -5.47, 95%CI; -10.2- -0.6, P = 0.02), an increase in creatinine (B = 17.73, 95%CI; 8.17-27.29, P = 0.001) and urea (B = 6.09, 95%CI; 2.57-9.61, P = 0.001) before the surgery, the risk of fall after CABG surgery increases. Conclusion: Several factors can increase the risk of falls after CABG surgery. Considering that the risk of falls in patients undergoing CABG surgery in most medical centers is examined only at the beginning of admission, it is recommended to consider the possibility of postoperative falls based on the predicting variables.

The effect of virtual reality distraction on reducing patients' anxiety before coronary angiography: a randomized clinical trial study

Background

Coronary angiography is used as a qualified method to diagnose coronary heart disease. However, patients undergoing coronary angiography experience a great deal of anxiety. The present study is aimed at investigating the effect of virtual reality on anxiety before coronary angiography. In a randomized controlled trial, 60 candidates for coronary angiography were randomly assigned to two intervention and control groups from April to July 2019. Data were collected by Spielberger’s situational anxiety questionnaire. The participants’ anxiety level and their heart rate, respiratory rate, and blood pressure were measured before and immediately after the intervention. The Intervention group received virtual reality intervention, and the control group was cared for based on the hospital routine. Data were entered into the SPSS version 24.0 software (SPSS Inc.) and analyzed using Chi-square, Paired samples, and independent sample t tests.

Results

The majority of participants were male (71.25%) and the Mean ± SD age of them in the intervention and control groups was 50.95 ± 4.120 and 52.08 ± 4.002 years, respectively. The mean score of anxiety (p < 0.01), heart rate (p = 0.001), and systolic blood pressure (p = 0.016) after the intervention in the intervention group decreased significantly.

Conclusions

This study indicated the implementation of a VR distraction protocol in the patients could effectively reduce perioperative anxiety and its indices. It showed that VR is a safe method without any complications related to the device and with good acceptability.

Registration code IRCT201 40515017693N3.

The Relationship between Living Environment and Life Satisfaction in Residents of Rasht City, North of Iran

Introduction: Life satisfaction reflects an individual's overall feelings about life, influenced by various factors. Objective: This study aimed to identify and introduce the indices related to the living environment that affect life satisfaction. Materials and Methods: This study was performed on 1000 residents of 55 neighborhoods of Rasht City (north of Iran) by an analytical cross-sectional method. The participants were chosen with a multistage cluster sampling method. The study data were collected using questionnaires, including the residents' characteristics, indicators of the living environment, and the satisfaction with life scale. The obtained data were analyzed using descriptive statistics, and inferential statistics, including the Pearson correlation coefficient, independent t test, analysis of variance, and linear regression. Results: Based on the present study results, the mean±SD age of the subjects in the study was 43.73 ±15.55 years. The analysis showed that their level of life satisfaction was average mean ±SD: 19.41 ±7.63, range: 5-35). The regression analysis identified dissatisfaction of facilities (B= -0.366; 95%Cl : -0.434, -0.298; P= 0.001), satisfaction with living in the local area (B= 0.248; Cl: 0.123, 0.373; P= 0.001), duration of residence (B: -0.364;95% Cl: -0.625, -0.102; P= 0.006) and gender (women compared to men) (B: 0.896; Cl: 0.011, 1.781; P=0.047) as the predictors of life satisfaction. Conclusions: According to the results, the life satisfaction of our study participants was at a moderate level and was affected by living environment indicators, especially facilities.

Predictors of Length of Stay in Intensive Care Unit after Coronary Artery Bypass Grafting: Development a Risk Scoring System

Introduction

To determine predictors of length of stay (LOS) in the intensive care unit (ICU) after coronary artery bypass grafting (CABG) and to develop a risk scoring system were the objectives of this study.

Methods

In this retrospective study, 1202 patients' medical records after CABG were evaluated by a research-made checklist. Tarone-Ware test was used to determine the predictors of patients' LOS in the ICU. Cox regression model was used to determine the risk factors and risk ratios associated with ICU LOS.

Results

The mean ICU LOS after CABG was 55.27±17.33 hours. Cox regression model showed that having more than two chest tubes (95% confidence interval [CI] 1.005-1.287, Relative Risk [RR]=1.138), occurrence of atelectasis (95% CI 1.000-3.007, RR=1.734), and occurrence of atrial fibrillation after CABG (95% CI 1.428-2.424, RR=1.861) were risk factors associated with longer ICU LOS. The discrimination power of this set of predictors was demonstrated with an area under the receiver operating characteristic curve and it was 0.69. A simple risk scoring system was developed based on three identified predictors that can raise ICU LOS.

Conclusion

The simple risk scoring system developed based on three identified predictors can help to plan more accurately a patient's LOS in hospital for CABG and can be useful in managing human and financial resources.

Endotracheal Tube Duration in Elderly Patients after the Coronary Artery Bypass Grafting Surgery

BACKGROUND

In elderly patients, the management of the endotracheal tube after coronary artery bypass graft (CABG) can be challenging because they often have complex comorbidities. This study was done to determine endotracheal tube duration in elderly patients after CABG.

MATERIALS AND METHODS

This retrospective study was conducted on 397 patients aged over 65 years under mechanical ventilation after CABG. Patients in two groups of endotracheal tube duration of less than 8 h and more than 8 h were compared. Medical records were used for data gathering. Descriptive statistics, Mann-Whitney U, Kruskal-Wallis test, and logistic regression model were used for data analysis.

RESULTS

Endotracheal tube duration was 9.9± 5.89 h in elderly patients. According to the results of the Mann-Whitney U test, there was a significant difference between the two groups in terms of the history of smoking (p = 0.023), history of diabetes (p= 0.062), left ventricular ejection fraction (p= 0.028), and type of operation in terms of emergency and non-emergency (p= 0.069). The logistic regression model showed predictive variables of the endotracheal tube duration after CABG in elderly patients over 65 years, including the history of smoking (1.179- 4.543, CI: 95%, β=0.839, and, p=0.015), history of myocardial infarction (0.188- 1.019, CI: 95%, p= 0.055, β= -0.827), and the left ventricular ejection fraction less than 50% (0.202-0752, CI: 95%, p= 0.005, β= -0.943).

CONCLUSION

Considering the predictive factors, the duration of the postoperative endotracheal tube can play an important role in the careful care of elderly patients after CABG.

Comparison between a nurse-led weaning protocol and a weaning protocol based on physician's clinical judgment in ICU patients

PURPOSE

The purpose of this study was to compare a nurse-led weaning protocol with a physician-driven weaning protocol in mechanically ventilated (MV) patients.

METHODS

In this quasi-experimental study with a one-group design, a total of 65 ICU patients, requiring MV for more than 72 h, were selected via convenience sampling. In routine practice, the physician's clinical judgment is needed to determine the patient's readiness for liberation from MV. A physician-driven weaning protocol was compared with a nurse-led protocol, using Burn's Weaning Scale (BWS) in three working phases. Descriptive and inferential statistics were measured for data analysis using SPSS version 16.

RESULTS

Based on BWS, the mean MV duration was 111.75±33.46 h in the nurse-led weaning group and 125.12±43.43 h in the physician-driven weaning group. There was a significant difference in terms of MV duration between the two groups (P = 0.000).

CONCLUSION

The present findings showed that nurses' assessment of patient's readiness for weaning from MV (BWS) is a safe approach during the day, which can reduce MV duration more than other typical methods in ICUs.

Research priorities in Evidence-Based Nursing Cares: A Delphi Technique

Introduction: Determining the research priorities in Evidence-Based Nursing Care is considered as a regular method to provide substantive information for developing the nursing science and taking evidence-based practical steps but such research is currently minimal. Therefore, a Delphi survey was conducted to determine the research priorities in Evidence-Based Nursing Care in the North of Iran. Methods: A three-round Delphi study was conducted to identify research priorities in Evidence-Based Nursing Care. The study comprised of research nurses, who have attended a Research Methodology course and did have published research. A Delphi expert panel consists of a group of credible experts within the field attending in consensus meetings to determine the nursing research top priorities. Open-ended questions were analyzed using thematic content analysis. Analysis of questionnaires 2 and 3 entailed an examination of the mean scores for each priority ranked on the five-point Likert scale. Results: Round 1 had 42 themes across 174 topics, identified by analyzing the data. In Round 2, respondents ranked all themes and 30 themes were selected. Finally, in Round 3, the top five research priorities emerged as the following: Assurance in health care, nurse-patient communication, pain management, taking care of the patients under mechanical ventilation and drug care. Conclusions: Determining research priorities in the Evidence-Based Nursing Care would optimize the level of utilization of the results of the studies by nurses and subsequently could improve the delivery of evidence-based nursing services; Prioritization will also help in directing resources to the essential research needs.  

Smoking cessation: Adherence based on patients' illness perception after coronary artery bypass grafting surgery

Background

Coronary artery bypass grafting surgery (CABG) is a common treatment for coronary artery disease. The patient’s commitment to modify risk factors is necessary to achieve the desired after surgery outcomes. The current study aimed at determining illness perception of patients after CABG, its relation to smoking cessation, and detecting other predictors of smoking cessation.

Methods

The samples of the current cross sectional study were selected from a greater study that was done on patients’ adherence determining for 6 months after CABG surgery. Data collection was performed using a telephone questionnaire with 3 sections: personal and social information, smoking cessation, and illness perception. Data analysis was performed via descriptive statistics, independent t test, and multiple logistic regression analysis through SPSS version 16.

Results

The findings showed that 26.6% of the patients had not stopped smoking for 6 months after CABG, and the mean score of illness perception was 83.28 ± 6.11. The relationship between adherence to smoking cessation and illness perception was not significant. Regression logistics via backward selection to detect factors related to smoking cessation adherence after CABG showed only a lack of hypertension history could predict adherence to smoking cessation (OR = 0.199, P = 0.03).

Conclusions

Based on the results, about one-third of the subjects smoked cigarettes after CABG; therefore, it is critical to plan rehabilitation programs regarding smoking cessation after this surgery.

Depressive symptoms effect on self care behavior during the first month after myocardial infarction

Aim:

To determine the effect of severity of depression symptoms on self care behavior in 15th and 30th day after myocardial infarction (MI).

Materials and Methods:

Gathering data for this cross sectional study was done by Beck depression and self care behavior questionnaires in a heart especial hospital in Rasht in north of Iran. Sample size was 132 after MI patients and data collected from June 2011 to January 2012.

Results:

Scores of depression symptoms in 15th and 30th day after MI and score of self care behavior in these days had significant difference (P<0.0001). Spearman test showed self care behavior had significant relationship with depression symptoms (P<0.0001). GEE model also showed with control of socio demographic and illness related factors, depression symptoms can decrease self care behavior scores (P<0.001).

Conclusion:

Severity of depression symptoms increase in 15th to 30th day after MI. This issue can affect on self care behavior. This issue is emphasized on nurses’ notice to plan suitable self care program for these patients.

The Study of Cognitive Function and Related Factors in Patients With Heart Failure

Background:

Cognitive impairment is increasingly recognized as a common adverse consequence of heart failure. Both Heart failure and cognitive impairment are associated with frequent hospitalization and increased mortality, particularly when they occur simultaneously.

Objectives:

To determine cognitive function and related factors in patients with heart failure.

Materials and Methods:

In this descriptive cross-sectional study, we assessed 239 patients with heart failure. Data were collected by Mini Mental status Examination, Charlson comorbidity index and NYHA classification system. Data were analyzed using descriptive statistics, Kolmogorov-Smirnov test, chi-square test, t-test and logistic regression analysis.

Results:

The mean score of cognitive function was 21.68 ± 4.51. In total, 155 patients (64.9%) had cognitive impairment. Significant associations were found between the status of cognitive impairment and gender (P < 0.002), education level (P < 0.000), living location (P < 0.000), marital status (P < 0.03), living arrangement (P < 0.001 ), employment status (P < 0.000), income (P < 0.02), being the head of family (P < 0.03), the family size (P < 0.02), having a supplemental insurance (P < 0.003) and the patient’s comorbidities (P < 0.02). However, in logistic regression analysis, only education and supplementary insurance could predict cognitive status which indicates that patients with supplementary insurance and higher education levels were more likely to maintain optimal cognitive function.

Conclusions:

More than a half of the subjects had cognitive impairment. As the level of patients cognitive functioning affects their behaviors and daily living activities, it is recommended that patients with heart failure should be assessed for their cognitive functioning.