[Barriers of readmission control among patients with congestive heart failure: a qualitative study]

Hospital readmission rate as a global health problem has increased over the last few decades. Congestive heart failure [CHF] is one of the most common causes of hospital readmission. Little is known about barriers of readmission rate control. The aim of this study was used for data exploring the barriers of readmission rate control. A qualitative study was designed with grounded theory approach. Data were gathered with interview. This study was started with proposly sampling and continues with theoretical sampling during 6 months. A convenience sample of 42 people was recruited from two public educational hospitals in Tehran during 6 month. The data were analyzed using constant comparative analysis. Data analysis demonstrated lake of sensitivity on barriers of readmission; incorrect patients' health believes and expectations; insufficient patient education, drug and diet adherence, and incorrect life style; lack of active medical system, distrust on physicians and lack of communication; psychological issues and patient-family challenges, were as the barriers of readmission control. This research had shown that the barriers of readmission control recognized by applying Qualitative research method with source triangulation better than the biomedical approach with single source. On the other hand, lack of sensitivity of participants on barriers of readmission control is a new finding. So, for controlling the barriers of readmission despite of exploring the barriers, making sensitive of involved people to readmission, is also proposed

Unusual intraoperative fracture of a 21mm Regentr St. Jude Medical [SJM] Valve

A case of aortic valve replacement [AVR] with St. Jude Medical [SJM] Regent_ valve no 21, that was fractured intraoperatively and replaced with a SJM Regent_ valve no 19, is reported here.The fracture point was ring part of the valve that has not been reported yet

Successful infertility treatment and spontaneous pregnancy in an unconsummated marriage after 7 years

About ten percent of people are suffering from sexual disorders in Iran and studies show that 50 percent of divorces are due to sexual disorders, too. If couples with sexual disorder receive consultation and undergo proper treatment, half of these divorces will not occur. An unconsummated marriage [UCM] is a marriage in which the couples have never had coitus, Etiological factors of UCM are varied: Psychogenic factors are the most prevalent and the main psychogenic factor is [Performance anxiety]. This report is about a couple who attended [Avesina Infertility Clinic] after 7 years of UCM with a chief complaint of infertility and expression of their will to become pregnant. A team composed of a gynecologist, an andrologist and a psychiatrist achieved a successful treatment goal within 3 months. Gynecological examination of the female was normal. Andrological examinations of the male showed severe premature ejaculation and male factors impairment in his semen analysis but psychiatric evaluation showed that the couple had low sexual information and the male had high stress and phobia at the time of intercourse. Finally, by dual-sex therapy and sensate focus exercises the couple experienced the first intercourse after 3 months and the female became pregnant 3 months later. Regarding the lack of necessary information on sexual issues and performance anxiety as the common cause of the disorder, it seems that teachings on sexual relationships might be a necessary part of pre-marriage counseling. On the other hand, a comprehensive and simultaneous evaluation of the couples with the sexual disorder by a harmonious expert team may increase treatment success rates

case report of recurrent hydrops fetalis due to maternal alloimmunization with Kell antigen

During pregnancy, irregular blood group antibodies originating either from earlier pregnancies or from blood transfusions may severely affect child health. In this report, a case of maternal alloimmunization to Kell antigen is described.The mother had a history of partial mole and four repeated intrauterine fetal death due to hydrops fetalis.Screening of irregular blood group antibodies revealed that she has anti-Kell with the titer of 1:4096. Also in genetic analysis, a C677T homozygous mutation of MTHFR gene was found, which could potentially enhance destructive effects of anti-Kell antibody. The described case emphasizes the importance of being informed about the presence of irregular blood group antibodies during pregnancy which may cause recurrent hydrops

Comparison of PCT after vaginal and oral bromocriptine use in women with hyperprolactinemia and infertility

Hyperprolactinemia is the most common cause of amenorrhea and infertility. Oral bromocriptine is the drug of choice for the treatment of hyperprolactinemia. Due to complications of its oral use, vaginal bromocriptine has been introduced as an effective and safe method. There is limited information regarding possible side effects of vaginal bromocriptine on motile sperm count in PCT results. Thus, in this clinical cross-sectional study, we sought to determine possible effects of vaginal bromocriptine on motile sperm count in PCT after resumption of ovulatory cycle in outpatients in reproductive age with hyperprolactinemia and complaints such as galactorrhea, menstrual irregularity and infertility. After exclusion of all confounding factors, the patients were divided in two groups. The study group [n=11] was treated with vaginal bromocriptine 2.5mg daily, and the control group [n=15] was treated with oral bromocriptine 2.5-5mg daily. Treatment duration needed for marked reduction in prolactine and also initiation of menses and ovulatory cycles were evaluated in both groups. After restoration of ovulation, PCT was done on 13-14th day of cycle in the presence of good cervical mucus, 8-12 hours after coitus. The numbers of motile sperm count atozoa/HPF in both groups were recorded and statistically compared with Mann Whitney U test. Treatment durations needed for initiation of ovulatory cycles in study group and the control group were 4-8 [mean5.5] weeks and 4-7 [mean 5.8] weeks, respectively with no statistical difference [p>0.05]. PCT results showed 11-20 [mean15.3] motile sperm/HPF with progressive forward movement in study group, who were treated with vaginal bromocriptine. By using oral bromocriptine, PCT showed 10-23 [mean 14.4] motile sperm/HPF with progressive forward movement in the control group. There were no statistical difference in PCT results between these two groups [p>0.05]. These results suggests the hypothesis, that vaginal bromocriptine has no adverse effects on motile sperm count in PCT, and vaginal bromocriptine can be used safely without possible adverse effect on sperm function in women with hyperprolactinemia and infertility. However, larger studies with more cases are necessary to confirm this hypothesis and to determine if vaginal bromocriptine has any effect on fertility in both groups

PCO Prevalance in adolescents with menstrual irregularity

This is a comparative cross - sectional prospective study with the aim of evaluation of prevalence and correlation between menstrual irregularity and PCO in postmenarcheal age. This evaluation has done in two groups of healthy adolescent girls 12-19 years old who admitted in shahid Mostafa Khomeini hospital, IRIB Clinic and a private clinic. We compared 47 adolescent girls who had irregular menstruation [as study group] with 22 adolescent girls who had normal menses [as control group] We did abdominal ultrasonography [US] in both groups and evaluated US features of PCO on them. This research shows that PCO was seen to be more common in adolescent girls with menstrual irregularity [42/5% vs 13.6%, p < 0.011] with a tendency to be more frequent in oligomenorrhea-amenorrhea group than in polymenorrhea [51.6% vs 25% P > 0.08]. We have also seen increased LH/FSH in 86.9% and abnormal androgens profiles in 69.5% in girls with PCO. These results suggest that US changes compatible with PCO is a frequent finding in adolescent girls with menstrual disturbance preferably in those with oligoamenorreha

[Comparison of quality and early postoperative complications between Laparascopy and Laparotomy in 112 women undergoing tubal ligation]

The aim of this study was to evaluate the quality, effective ness and the ideal method of tubal ligation with low comolication, low bleeding and early recovery. In this investigation we compared the early complications and the quality of operations in two different tubul ligation techniqwes on totally 112 women who were operated in two centers in Tehran, Iran; In onc group [53 women] tubal ligation was carried out by laparascopy [with clips and cautery, whereas the other group [59 women] was operated using Pomeroy technique in laparotomy. Collection of information was done using questionare and case selection and grouping was performed randomly. The results showed that the duration of operation and hospitalization as well as the amount of bleeding were less in laparascopy group than in laparatomy group [P<0.05]. Moreover, women in laparascopy group could completely retain their activity more rapidly than the other group. Hematoma and infection were only slightly higher in patients in laparatomy group [P>0.05]. Whereas pain occurred more alien in the laparatomy group [P<0.05]. It can be concluded that complications occur less often in the laparascopy goup in compoarison with lapattony goup and tubal ligation with laparascopy can be considerd as a better and safer method