Reducing Irrational Beliefs and Pain Severity in Patients Suffering from Non-Cardiac Chest Pain (NCCP): A Comparison of Relaxation Training and Metaphor Therapy

BACKGROUND: Patients suffering from non-cardiac chest pain (NCCP) can interpret their chest pain wrongly despite having received a correct diagnosis. The objective of this study was to compare the efficacy of the relaxation method with metaphor therapy for reducing irrational beliefs and pain severity in patients with NCCP. METHODS: Using a randomized controlled trial, 33 participants were randomly divided into a relaxation training group (n= 13), a metaphor therapy group (n = 10), and a control group (n = 10), and were studied for 4 weeks. The two tools used in this research were the Brief Pain Inventory (BPI) index for determining the degree of pain and the short version of the Jones Irrational Belief Test. Metaphor therapy and a relaxation technique based on Ost's treatment were used as the interventions. The collected data were analyzed with a multivariate analysis of covariance (MANCOVA), a Chi-square test, and the Bonferroni procedure of post-hoc analysis. RESULTS: The relaxation training method was significantly more effective than both metaphor therapy and the lack of treatment in reducing the patients' beliefs of hopelessness in the face of changes and emotional irresponsibility, as well as the pain severity. Metaphor therapy was not effective on any of these factors. In fact, the results did not support the effectiveness of metaphor therapy. CONCLUSIONS: Regarding the effectiveness of the relaxation method as compared with metaphor therapy and the lack of treatment in the control group, this study suggests that relaxation should be paid greater attention as a method for improving the status of patients. In addition, more studies are needed to determine the effectiveness of metaphor therapy in this area.

Anesthetic management in complex arch surgery: debranching of innominate and left common carotid arteries in extensive aortic dissection without cardiopulmonary bypass

Aortic dissection begins with the formation of a tear in the aortic intima, and it directly exposes an underlying diseased medial layer to the driving force of the intraluminal blood. This blood penetrates the diseased medial layer and cleaves the media longitudinally, thereby dissecting the aortic wall. Herein, we report the case of a 38-year-old woman, who presented with chest pain and dyspnea. After physical examination, laboratory evaluation, echocardiography, and CT-angiography, extensive aortic dissection was diagnosed involving the innominate and left common carotid arteries. Accordingly, the debranching of the aortic arch arteries was performed. During the procedure, the patient was monitored with bilateral regional cerebral tissue oximetry. The patient did not show any signs of complications either in the postoperative period or at postoperative three-month weekly follow-up or at subsequent monthly follow-up for the past year

Off-pump coronary bypass grafting causing stunned myocardium

The term "stunned myocardium" refers to abnormalities in the myocardial function following reperfusion and is common in on-pump coronary artery bypass grafting [CABG] and is exceedingly rare in off- pump CABG. A 53-year-old man presented with unstable angina due to the severe stenosis of the left anterior descending coronary artery [LAD] and the obtuse marginal. Laboratory findings and Chest X-ray revealed nothing abnormal. The intraoperative course was uneventful. The patient left the operating room without any inotropic support. Six hours later, however, he developed low cardiac output .At exploration, cardiac tamponade was excluded and flowmetry showed that the graft had adequate function. Cardiac enzymes were normal. High-dose adrenalin and Dobutamine were administrated and an intra-aortic balloon pump was used. After hemodynamic stabilization, the patient left the Intensive Care Unit without an intra-aortic balloon pump and inotropic support. On the fifth postoperative day, coronary angiography showed patent grafts and correct anastomotic sites. On the seventh postoperative day, the akinetic lateral wall of the left ventricle changed to dyskinesia. Finally after hospital discharge on the thirtieth postoperative day, an echocardiogram showed normal left ventricular function without regional wall motion abnormalities.

Views of users towards the quality of hospital information system in training hospitals affiliated to Mashhad University of medical sciences

Users of Hospital Information System know its problems better than others. Studying their views are very important and can be especially effective in the development of the information system. The aim of this study was to investigate the users' views towards the quality of Hospital Information System in the training hospitals of Mashhad University of Medical Sciences. The current study was an applied research which was conducted with descriptive cross-sectional method. A four-section questionnaire was designed for data collection consisting of characteristics of quality information, reasons of low quality of information, accessibility of information and decision support. Validity and reliability were tested and SPSS was used for data analysis. The finding indicated that 62.8% of users explained that one of reasons of low quality information was a problem related to obtaining information. About 47.7% of users were unsatisfied with hospital information system ability for decision making support. In general 53.2% of users were slightly satisfied with the overall quality information of the system. According to the findings of this study there are some problems concerning information quality of Hospital Information System in Mashhad training hospitals. These problems include of inappropriate information quality of the system and incompatibility with user needs which leads to decreased satisfaction of users towards the system

[Evaluation of structure and content of websites of the educational hospitals in Iran - 2007]

Nowadays, various tools are used in health informatics; the type of these tools should be related to the patients' and healthcare providers' needs. Hospital websites are suitable systems for data exchange and communication between patient and healthcare providers. This study performed for analysis and evaluation of structure and content of websites of the educational hospitals in Iran. In a descriptive study, 8 Iranian educational hospital websites were analyzed for structure, content and related links by using 4 researcher made check lists. The average score was 12/30 for structural analysis. 5.75/15, 2.6/19, and 2/24 were calculated scores for of, content analysis of homepage, [about us] page, and other links, respectively. In general, the structure of Iranian educational hospital websites is at medium level and their content is at very weak level