ABSTRACT
Introduction: Considering the increased expenditure in public health sector, especially the increased cost in hospitals and clinics, there is an urgent need to control these costs mainly by ensuring adherence to clinical guidelines for diagnostic procedures. In this study we aim to investigate the adherence of heart clinics to guideline for exercise tolerance test. Methods: This cross-sectional study was performed on 308 patients who were referred for ECG exercise test in 3 clinics located in the city of Shiraz, Iran in 2018. Demographic and clinical data were recorded and the indications of exercise test for each patient was reviewed according to the ACC/AHA guideline for exercise tolerance test. Results: Exercise tests were found to be inappropriately done in 121 (39.3%) participants. Among the patients for whom the test was done without indication 79 (65.3%) were women and the gender difference was statistically significant (P < 0.01); women were 18.5% more likely to undergo exercise test without indication. There was more inappropriate tests among nonanginal pain subsets comparing to other presenting symptoms (P < 0.001). Age, coronary risk factors, reason for performing exercise tests and private health system were not predictors of inappropriate use (P > 0.05). Conclusion: This study confirms that more than one third of exercise tests done in the participants are inappropriate. Wide availability of exercise test makes it vulnerable to overuse and additional unnecessary cost to health care systems.
ABSTRACT
INTRODUCTION: High sensitive C-Reactive Protein (hs-CRP) is increased in acute and chronic rheumatic fever (RF), but is unknown whether serum levels of hs-CRP is correlated with late restenosis of mitral valve (MV) after Percutaneous transvenous mitral commissurotomy (PTMC). The aim of this study is to determine relationship between hs-CRP and MV restenosis 48-36 months after performing PTMC. METHODS: A total of 50 patients who had undergone PTMC due to rheumatic etiology (41 female, 9 male; mean age 46 ± 11, range 27-71), all followed up on an out patients basis 36 months after PTMC, were included in the study. The hs-CRP was measured using an enzyme-linked immunosorbent assay (ELISA) kits. RESULTS: No association was found between hs-CRP level and mean transmitral valve gradient 36 months after PTMC, MV area by planimetry, pulmonary artery systolic pressure, mitral regurgitation grade, left atrial diameter, atrial fibrillation (AF) rhythm and Wilkins score. CONCLUSION: Our study have shown that there is no association between hs-CRP and MV restenosis in patients with rheumatic heart disease (RHD) who underwent PTMC. Therefore, it has been postulated that inflammation is not a cause of post PTMC restenosis.
ABSTRACT
BACKGROUND: Myocardial infarction (MI) is a life threatening disease that influences the physical, psychological and social dimensions of the individual. Improper lifestyle is one of the causes of this disease. The use of nursing models could be one of the important and fundamental steps in changing the risk factors associated with MI. This study was carried out to evaluate the effect of continuous care model on the lifestyle of patients with MI. METHODS: This randomized clinical trial was carried out on 70 patients with MI in coronary care units of hospitals affiliated to Shiraz University of Medical Sciences. Enrolled patients were randomly assigned to intervention or control groups using a randomization list (random permutated blocks with length 4). The continuous care model was used for 35 patients in the intervention group for a period of 3 months and in the control group, the usual cares were applied for 35 patients. Data were collected through lifestyle questionnaire before the intervention and 3 months after. The data were analyzed using chi-square, independent t-test and paired t-test. RESULTS: Patients in the intervention group showed significant improvements in lifestyle (125.6 ± 15.4 vs. 180.1 ± 19.9). Moreover, the lifestyle score of intervention group was significantly better than that of the control group (117.9 ± 22.0 vs. 180.1 ± 19.9; P < 0.001) after three months. CONCLUSION: Applying a continuous care model had positive effects on the lifestyle of patients with Myocardial Infarction. In order to reduce the risk factors and improve the lifestyle of patients with MI, nurses could use this model to create an effective change.
