arly u ervised ncremental esistance raining (ESpIRiT) following cardiac surgery via a median sternotomy: a study protocol of a multicentre randomised controlled trial

INTRODUCTION

There is no consistency in current practice pertaining to the prescription and progression of upper limb resistance exercise following cardiac surgery via median sternotomy. The aim of this study is to investigate whether less restrictive sternal precautions with the addition of early-supervised resistance training exercise improves upper limb function and facilitates recovery following median sternotomy.

METHODS AND ANALYSIS

This is double-blind randomised controlled trial, with parallel group, concealed allocation, blinding of patients and assessors, and intention-to-treat analysis. 240 adult participants who had median sternotomy from eight hospitals in Malaysia will be recruited. Sample size calculations were based on the unsupported upper limb test. All participants will be randomised to receive either standard or early supervised incremental resistance training. The primary outcomes are upper limb function and pain. The secondary outcomes will be functional capacity, multidomain recovery (physical and psychological), length of hospital stay, incidence of respiratory complications and quality of life. Descriptive statistics will be used to summarise data. Data will be analysed using the intention-to-treat principle. The primary hypothesis will be examined by evaluating the change from baseline to the 4-week postoperative time point in the intervention arm compared with the usual care arm. For all tests to be conducted, a p value of <0.05 (two tailed) will be considered statistically significant, and CIs will be reported. The trial is currently recruiting participants.

ETHICS AND DISSEMINATION

The study was approved by a central ethical committee as well as the local Research Ethics Boards of the participating sites (UKM:JEP-2019-654; Ministry of Health: NMMR-50763; National Heart Centre: IJNREC/501/2021). Approval to start was given prior to the recruitment of participants commencing at any sites. Process evaluation findings will be published in peer-reviewed journals and presented at relevant academic conferences.

TRIAL REGISTRATION NUMBER

International Standard Randomised Controlled Trials Number (ISRCTN17842822).

Trajectory of Change in Erectile Dysfunction Symptoms Following Coronary Artery Bypass Surgery in Malaysian Population

INTRODUCTION: Despite the advantages of Coronary artery bypass surgery (CABG), this procedure has been reported to have a significant impact on sexual activity. The study aims to assess the trajectory of change in erectile dysfunction (ED) symptoms following CABG.METHODS: 73 adult male participants were recruited. Participant primary data was measured using the International Index of Erectile Dysfunction (IIEF-5) at three-time points. RESULTS: Severe ED was most prevalent during 6 weeks following-operation (86.3%); however, the proportion of severe ED symptoms reduced after 4 months following-operatively (42.5%). There was a statistically significant difference in ED symptoms between pre-operatively and 6 weeks post- operatively (p< 0.001). At 4 months, there was a marginally significant improvement in ED symptoms compared to baseline pre-operatively post CABG (p = 0.064). Age significantly increases the chance in odds of having abnormal ED symptoms by 22% at 4 months postoperatively (aOR=1.22, 95% CI=1.06, 1.41, p<0.05). Other risk factors for abnormal ED symptoms following CABG, which include normal creatinine clearance, being a smoker, and having moderate to good LV function was not statistically significant. CONCLUSION: The present study has demonstrated a high prevalence of ED following CABG and the procedure caused a negative impact on the ED symptoms. However, there was a significant improvement in ED symptoms as the time from surgery increases and patients recovered. Further studies with larger sample size and longer recovery time are needed to assess the trajectory of recovery in ED symptoms in this population.>< 0.05). Other risk factors for abnormal ED symptoms following CABG, which include normal creatinine clearance, being a smoker, and having moderate to good LV function was not statistically significant. CONCLUSION: The present study has demonstrated a high prevalence of ED following CABG and the procedure caused a negative impact on the ED symptoms. 

Modelling decision support system for selection maahad tafiz center using analytical hierarchal analysis

<p>Today, the interest of the community to send their children to religious-based schools that is Maahad Tahfiz Center (MTC)) whether managed by Government (State or Federal), private individuals, nonprofit organization (NGO) or certain organizations is very high. The demand that exceeds this offer has seen the growth of MTC rapidly. This situation provides many choices and advantages to parents. However, there is anxiety among parents to choose the MTC that fulfills the features that they want.  Hence modeling decision support system (DSS) in a MTC selection has been modeled using Analytical Hierarchy Process (AHP) provides the effective way for parents to select appropriate MTC. AHP is an effective tool for dealing with the complex decision making and aid the parents to set priorities and provide the best decision in selection MTC. Hopefully by using this model and future development of this model will help the parents make the best choices of MTC based on their preferences. </p>