Adherence to lifestyle changes after coronary artery bypass graft: Outcome of preoperative peer education.

OBJECTIVE: This study was done to investigate the effect of preoperative peer education on patients' adherence to medication and lifestyle changes after Coronary Artery Bypass Graft (CABG). METHODS: In this randomized clinical trial, the peers of CABG patients conducted preoperative educational sessions at the ward in groups of 4-5 (n = 36) while the control group (n = 34) received routine education by a nurse. Adherence of both groups to medication and recommendations for lifestyle modification including physical activity, smoking, and diet was measured one and two months after discharge. RESULTS: A multivariate analysis of co-variance showed the significant effect of peer education on adherence (F = 32.586, p < 0.001; η2 = 0.671). Univariate ANCOVA revealed a significant difference in adherence to diet between the two groups (F = 62.316, p = 0 0.0001; η2 = 0.482). Based on the repeated measures ANOVA, peer education significantly improved the CABG patients' adherence to diet (F = 55.373, p = 0.0001) and their total adherence (F = 9.911, p = 0.002) compared to the control group. CONCLUSION: Preoperative peer education had a significant effect on improving CABG patients' adherence to lifestyle changes after hospital discharge. PRACTICE IMPLICATION: Peer education can be used as an effective method to improve the CABG patients ' adherence to lifestyle changes.

Developing a genetic fuzzy system for risk assessment of mortality after cardiac surgery.

Cardiac events could be taken into account as the leading causes of death throughout the globe. Such events also trigger an undesirable increase in what treatment procedures cost. Despite the giant leaps in technological development in heart surgery, coronary surgery still carries the high risk of the mortality. Besides, there is still a long way ahead to accurately predict and assess the mortality risk. This study is an attempt to develop an expert system for the risk assessment of mortality following the cardiac surgery. The developed system involves three main steps. In the first step, a filtering feature selection method is applied to select the best features. In the second step, an ad hoc data-driven method is utilized to generate the preliminary fuzzy inference system. Finally, a hybrid optimization method is presented to select the optimum subset of the rules. The study relies on 1,811 samples to evaluate the diagnosis performance of the proposed system. The obtained classification accuracy is very promising with regard to other benchmark classification methods including binary logistic regression (LR) and multilayer perceptron neural network (MLP) with the same attributes. The developed system leads to 100% sensitivity and 84.7% specificity, while LR and MLP methods statistically come up with lower figures (65, 78.6 and 65%, 75.8%), respectively. Now, a fuzzy supportive tool can be potentially taken as an alternative for the current mortality risk assessment system that are applied in coronary surgeries, and are chiefly based on crisp database.

Heart transplantation in iran; a comprehensive single-center review of 15-year performance.

BACKGROUND: Heart transplantation in Iran was first performed in July 1993. Since then, Shariati Hospital, affiliated to Tehran University of Medical Sciences, has been representing the most active center of cardiac transplantation in Iran and one of the major sites in the Middle East. This is a comprehensive review of our 15-year practice registry to make a scheme of our record and achievements. METHODS: Clinical data on all consecutive transplanted patients from the Department of Cardiac Surgery, Shariati Hospital, Tehran, Iran over the last 15 years were reviewed. Descriptive and analytical statistics were extracted in regard to recipients, donors, surgical characteristics, and current status of the patients on follow-up. RESULTS: Totally, 90 patients were transplanted since 1993; 11, 32, and 47 in three five-year periods, respectively. The mean age of the recipients was 29.30+/-13.17 years. Motor-vehicle accident was the main cause of brain death of donors (48.8%). The most common indication for surgery was idiopathic dilated cardiomyopathy (75.5%).The mean survival rate has been 6.66+/-0.87 years. One-year and five-year survivals had a rising trend through the five-year periods. Acute allograft rejection and infection were the two major events complicating our transplants. CONCLUSION: This study shows that despite a vast variety of obstacles, we have passed the primitive milestones. The number of transplants is increasing at a higher rate in recent years, and patients' survival rates and outcomes seem to be improving.

Transient bilateral cortical visual loss after coronary artery bypass grafting in a normotensive risk-free patient.

BACKGROUND: Postoperative blindness has been mentioned as a rare complication of heart surgery. The majority of reported cases are caused by retinal artery occlusion or ischemic optic neuropathy. We report a case of transient visual loss due to cortical ischemia after coronary artery bypass grafting (CABG). CASE REPORT: A 52-year-old nondiabetic man developed complete bilateral visual loss immediately after CABG. He had been normotensive throughout the operation. An ophthalmologic exam detected no causative ocular damage. The results of a Doppler study of the carotid, vertebral, and ophthalmic arteries were completely normal, and an echocardiography examination showed no left ventricular clot. Magnetic resonance imaging of the brain, however, showed several ischemic plaques in watershed areas and a small subacute infarct in the occipital lobe. Recovery began on postoperative day 4, and the patient's vision was restored in 6 months. CONCLUSION: Although most cases of visual loss after open heart surgery have been caused by injuries to the peripheral optic system, cortical blindness may occur following open heart surgery in the absence of any preexisting risk factor. Fortunately, the course of recovery is promising one, as it was for our patient.