Exploring the consequences of patient commitment to cardiac rehabilitation program: A qualitative study.

BACKGROUND: Commitment to implementing cardiac rehabilitation (CR) plays an important role in managing the problems caused by heart diseases. Commitment to the treatment plan implementation is accompanied by numerous positive consequences. This study was carried out to explain the consequences of commitment to CR. MATERIALS AND METHODS: Data were collected through semi-structured individual interviews with 26 participants (13 CR specialists and 13 patients), using purposeful sampling. Interview questions focused on the factors influencing the formation of commitment to the CR and its consequences. Conventional content analysis with Graneheim and Lundman's approach was used to analyze the data. To obtain data trustworthiness, Lincoln and Guba's criteria were used. RESULTS: The findings were classified in three categories: purposeful of a purposeful behavior structure (sense of controlling and managing the condition, sense of responsibility, sense of security), formation of active performance structure (interaction between the patient-family-treatment team, stabilization of behavior and prevention of intermittent behavior, no cessation of the treatment plan and adherence to it, directing behaviors and adaptation to conditions) and achieving dynamic and effective care (active follow-up of the treatment plan, sense of satisfaction, reduced readmission, reduced costs, improved quality of life, reduced anxiety and concerns about treatment failure, increased self-care ability). CONCLUSION: The results show that the patient's commitment to CR is accompanied by optimal consequences. The results of this study can help design the training plan for the CR staff and develop the clinical practice guidelines to provide educational-care approaches to patients to reinforce their commitment.

Development and Psychometric Evaluation of the Elderly Hypertension Self-Care Index.

PURPOSE: This study was done to develop and evaluate the psychometric properties of the Elderly Hypertension Self-Care Index. METHODS: This was an exploratory mixed method study. Items were developed through conducting a qualitative study with conventional content analysis approach and comprehensively reviewing the existing literature. Then, the developed index was assessed for face, content, and construct validity as well as reliability. RESULTS: Analyses identified four themes of self-care: intelligent acceptance, self-actualization in the pass of the disease, effective supporters, and destructive constraints. Exploratory factor analysis revealed that only 28 items were appropriate which were loaded on six factors, accounting for 45.035% of the total variance of hypertension self-care. Cronbach's alpha and test-retest intraclass correlation coefficients of the index were 0.80 and 0.96, respectively. CONCLUSION: The Elderly Hypertension Self-Care Index showed that it is a valid and reliable index in the elderly health context; and can be used for self-care assessment among elderly people with hypertension.

Effectiveness of local anesthesia with lidocaine in chronic opium abusers.

CONTEXT: It had been demonstrated that chronic opium abusers have lower pain thresholds compared with than non-abusers. AIMS: This study aimed to compare the required dose of lidocaine, a common local anesthetic drug, with regard to the onset of anesthesia in opium abusers with that in non-abusers undergoing similar suturing of minor hand lacerations. MATERIALS AND METHODS: In this study, 109 opium abusers and 91 non-abusers underwent similar suturing for hand lacerations known as digital block. We explained the patients that their case records would remain confidential and admitting to any history of opioid abuse could assist in alleviating any pain associated with the procedure. RESULTS: There was no statistically significant difference between the two groups with regard to age, gender, and cause of injury (P > 0.05). We found a significantly longer duration of onset of analgesia in nonopioid abusers (5.42 ± 1.93 min) than that in abusers (10.30 ± 1.79 min) (P < 0.001). In addition, the lidocaine dose administered to abusers (6.67 ± 1.21 ml) was higher (4.07 ± 1.26) as well as statistically significant (P < 0.001) than that in non-abusers. CONCLUSION: The findings from this study suggest a longer duration of onset of anesthesia and requirement of a higher lidocaine dose in opium abusers compared with nonopioid abuser. Moreover, chronic opium abusers (4-5 years) experienced significantly higher time of onset of anesthesia compared with nonchronic abusers. This outcome may be useful in selecting a more suitable local anesthetic protocol in such patients.