Perspectives of Cardiac Care Unit Nursing Staff about Developing Hospice Services in Iran for Terminally ill Cardiovascular Patients: A Qualitative Study.

INTRODUCTION: The present study was conducted aiming to determine the points of view of cardiac care units' nursing staff about designing and providing Hospice services in Iran for cardiovascular patients in the final stages of life. MATERIALS AND METHODS: In this qualitative study, the perspectives of 16 Cardiac Care Unit (CCU) nurses selected purposefully among hospitals of Tabriz-Iran University of Medical Sciences were investigated using semi-structured interviews and were analyzed in content analysis method. RESULTS: 33 themes were finally extracted. Some nurses were for and some were against designing and providing Hospice services in Iran. The main reasons identified for supporting this plan included: Possibility of designing and providing these services consistent with high ethical values of Iranian society; approval of authorities due to increasing the load of chronic diseases and aged population; need of families due to the problems in taking care of patients and life concerns; better pain relief and respectful death; decrease of costs as a result of lower usage of diagnostic-therapeutic services, less use of expensive facilities and drugs, and better usage of hospital beds. CONCLUSION: Growing load of chronic diseases has made the need for Hospice as a necessary issue in Iran. In order to provide these services, studying the viewpoints of health service providers is inevitable. Therefore using and applying the results of this study in planning and policy making about designing and providing these services in Iran for cardiovascular patients in their final stages of lives could be helpful.

Uses, Limitations, and Validity of a Registry of Congenital Anomalies in Iran: A Critical Review.

BACKGROUND AND AIMS: Preventive strategies of congenital anomalies are basically relying on the systematic ongoing collection and analysis of data and timely dissemination of information. The aim of this paper is to briefly report a critical review of a surveillance system of congenital anomalies in a developing country, by describing the challenges and experience of the registry since it began. METHODS: Tabriz Registry of Congenital Anomalies (TRoCA) was mainly set up based on the guidelines provided by the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR) for data collection, coding, process, analysis, use, and evaluation of the system. FINDINGS: TRoCA has successfully achieved its main objective as a pilot model for setting up a nationwide registry of congenital anomalies in the country. The programme has too succeeded in relation to its regional objectives: epidemiological rates and data have been produced consistently for etiological investigations, methodological studies, service provision, and preventive measures for selected anomalies. CONCLUSIONS: Our successful experience, as a small registry in a developing country, might be of interest and useful to practitioners, policymakers of birth defects control programmes, and mainly those willing to set up a monitoring system of congenital anomalies in similar areas.

Evaluation of Early and Intermediate Outcomes of Cryo-MazeProcedure for Atrial Fibrillation.

INTRODUCTION: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in patients with mitral valve disease affecting 50% of patients undergoing mitral valve surgery, contributing to increased risks of systemic embolization, anticoagulant- related hemorrhage and mortality. The maze procedure is an effective way to treat AF. Over the last several years, cryoablation was substituted for atrial incision in many reports to simplify the maze procedure. However, few studies have been carried out to evaluate the results of cryoablation surgery. In the present study we evaluated the results of this procedure. METHODS: In this cross sectional study, 47 AF patients were treated with Cryo-Maze surgery method. Rhythm assessment using electrocardiographic and echocardiographic survey was performed in all patients before surgery, during the patients' hospital stay, on discharge and after six months. RESULTS: Survival rate of the studied patients at six months was 93.6%. Sinus rhythm restoration rate in Cryo-Maze patients was 72.1% on discharge and 76.7% six months after their operation. CONCLUSION: The present study revealed that Cryo-Maze procedure is an effective and safe therapeutic modality in AF while normal sinus rhythm can be achieved in patients following this intervention.

Effect of citrate phosphate dextrose solution on reperfusion injury in coronary artery bypass surgical patients undergoing cardiopulmonary bypass.

INTRODUCTION: Reperfusion injury is one of the most common phenomena associated with coronary artery bypass graft (CABG) .The mechanism of ischemia and reperfusion injury is not known precisely, but may be free radicals and other activated oxygen metabolites have an important role in tissue damage following reperfusion injury. This study was to evaluation of citrate solution effects on oxidative stress and cardiac function and Cardiac enzymes in patient's candidate to CABG. METHODS: In Double blind clinical trial study in Tabriz University of medical science, 50 patients candidate to CABG randomly divided in two groups and matched together according to sex, age and NYHA class. In intervention group after surgery and before the opening of the aortic clamping solution warm blood containing citrate phosphate dextrose (CPD; 3cc/100cc), value (100cc/min/m2BSA) for three minutes was administered. In control group, only pure blood administered. Oxidative stress markers measured in five stages and cardiac enzymes measured in three stages of surgery. RESULTS: Mean age 62.3±9.1 years including 30(60%) men and 20(40%) women. Ejection fractions between two groups were not significant before and after treatment. Administration of CPD was not significant effects on cardiac enzyme. Measurement of oxidative stress in different time were not different in malonil dialdehyde, superoxide dismutase and GPx but total antioxidant status were improved after intervention in compared with control group (p<0.001). CONCLUSION: Results showed that CPD were positive effects of increasing in total antioxidant status after CABG, but in reduction of other oxidative markers were unlabeled.