The Effect of Virtual Reality, Music Therapy, and Stress Ball Application on Pain and Anxiety During Outpatient Gynecological Procedures: A Randomized Controlled Trial.

PURPOSE: The aim of this study was to determine the effect of virtual reality, music therapy, and stress ball applications, which are methods of distraction, on pain, anxiety, and patient satisfaction during outpatient gynecological procedures. DESIGN: This study was a randomized controlled trial with control and intervention groups, pre-test and post-test. METHODS: The study was conducted with 200 women who underwent gynecological surgical procedures without sedation in a state hospital on the European side of Istanbul between October 2022 and March 2023. There were four groups in the study: Virtual Reality (n = 50), Music Therapy (n = 50), Stress Ball (n = 50), and Control group (n = 50). Data were collected using a Descriptive Information Form, Visual Analog Scale, State-Trait Anxiety Inventory, Life Information Follow-up Form, and Patient Satisfaction Evaluation Form. The scales were completed separately by the investigator before the procedure, 10 minutes after the procedure, and 1 hour after the procedure. FINDINGS: A statistically significant difference between the intervention groups and control groups of women who underwent a gynecological procedure at the 10th minute after the procedure (P=.000) and at the 1st hour after the procedure (P=.000) was significant. State-Trait Anxiety Inventory of women by groups decreased after the procedure and showed a statistically significant difference (P =.000). Satisfaction scores of the women with the intervention according to the groups also showed a significant difference (P =.000). When the satisfaction scores of the women with the intervention were compared by groups, the satisfaction scores ranged from the highest to the lowest, as virtual reality, music therapy, and stress ball application, respectively. CONCLUSIONS: Virtual reality, music therapy, and stress ball applications, which are methods of distraction during the outpatient gynecological procedure, were effective in reducing anxiety and pain and increasing patient satisfaction.

The effect of virtual reality glasses applied during intrauterine device insertion on pain, anxiety and satisfaction: Randomized controlled study.

BACKGROUND AND AIM: This study was carried out to determine the effect of the use of "virtual reality glasses," on anxiety, pain, and satisfaction level in order to reduce anxiety and pain during intrauterine device (IUD) insertion, which is a painful and stressful procedure for women and to divert attention to increase satisfaction. METHODS: This randomized controlled study in the gynecology clinic of a state hospital with 80 women who were accepted to participate in the study. Data were collected using structured patient information form, numerical pain rating scale, state-trait anxiety inventory, patient satisfaction evaluation form, and virtual reality glasses. RESULTS: Post-procedural pain scores in the control group after IUD application were higher than post-procedural pain in the virtual reality group. Measurements of post-procedure anxiety in the control group were higher than measurements of post-procedural in the virtual reality group. Satisfaction levels of women with virtual reality glasses during IUD insertion were also found to be high. CONCLUSIONS: It was determined that the use of virtual reality glasses, one of the methods of distraction during IUD insertion, was effective in reducing pain and anxiety and increasing patient satisfaction.

The Effect of Home-Based Telehealth and Postpartum Care Given According to Watson's Theory of Human Caring on the Improvement in the Emotional State of the Mother During the Pandemic Process: A Case Report.

Objective: The purpose of this case report was to evaluate the effect of telehealth and postpartum care provided to a mother with maternal depression according to Watson's Theory of Human Caring during the pandemic on the improvement in the mother's emotional state and to evaluate the applicability of the model. Methods: Edinburgh Postnatal Depression Scale was administered to eight women who responded to the announcement made on social media, and verbal and written permission was obtained from the mother with the highest scale score. A total of six video calls were made with the mother via WhatsApp, twice a week in the first week after postnatal discharge and once a week in the next 4 weeks, in accordance with the form drawn up according to Watson's Theory of Human Caring. Results: In this study, it was observed that home-based telehealth and postpartum care provided using Watson's Theory of Human Caring, which includes a holistic approach, was very useful, and the care provided according to the model provided a positive improvement in the emotional state of the mother with depression. Conclusions: It was concluded that telehealth and postpartum care is useful in home-based care in extraordinary situations/quarantine conditions such as pandemic; care can also be provided in the form of telehealth service according to Watson's Theory of Human Caring to mothers with depression; and care provides positive improvement in the emotional state of mothers.

Evaluation of education and counseling using social media tools after discharge in women who underwent episiotomy.

In this study, it was aimed to evaluate the effects of post-discharge education and counseling using social media tools on wound healing, pain status, and care and practices for women with episiotomy. The study was conducted experimentally with 60 women (30 experimental, 30 control) who had vaginal delivery with episiotomy in a public hospital in Istanbul. Data were collected using a data entry form and evaluations on the REEDA (Redness, Edema, Ecchymosis, Discharge, Approximation) scale, VAS (Visual Analogue Scale), and Diagnostic Form for Episiotomy Care and challenges. In our study, training and counseling were given to the experimental group by making video calls via social media on the 3rd, 5th, 7th, and 14th postnatal days (PP), and the results were evaluated without any training to the control group. SPSS program was used for data analysis. There was no difference between the experimental and control groups in terms of demographic and obstetric data. It was determined that the total scores of the experimental group on the REEDA scale on the 7th postnatal day (x¯ =2.167 ± 0.747) were statistically significantly lower than the total scores of the control group on the REEDA scale on 7th postnatal day (x¯ =3.100 ± 0.923) (p = 0.000 > 0.05). It was determined that the total scores of the experimental group on REEDA scale on the 14th postnatal day (x¯ =0.200 ± 0.407) were also statistically significantly lower than the total scores of the control group on REEDA scale on the 14th postnatal day. (x¯ =1.333 ± 0.844) (p = 0.000 > 0.05). The VAS DS scores of the experimental group on 3rd (x¯ =4.733 ± 0.907) and the 5th (x¯ =3.267 ± 0.691) postnatal day were statistically significantly lower than the VAS DS scores of the control group on 3rd (x¯ =5.267 ± 0.944) and 5th (x¯ =3.933 ± 0.944) (p = 0.003 > 0.05) postnatal day. In the light of this information, it was found that scores on REEDA scale were lower and pain experiences were significantly less in the group that received education and counseling with social media tools after discharge in women who underwent episiotomy.

Impact of Earthquake on Cardiovascular Health: What Should Cardiovascular Healthcare Providers Anticipate After the Devastating Earthquakes in Turkey and Syria?

Natural disasters like earthquakes have direct and indirect association with major adverse cardiac events. They can impact cardiovascular health by multiple mechanisms not to mention their impact on cardiovascular care and services. Besides the humanitarian tragedy that calls attention globally, we as part of cardiovascular community are concerned with the short and long outcomes of those who survived the recent Turkey and Syria earthquake tragedy. Therefore, in this review, we aimed to draw attention of cardiovascular healthcare providers to the anticipated cardiovascular issues that may arise in survivors on short- and long-term postearthquakes to ensure proper screening and earlier management of this population. With the anticipated increase in natural disasters in future considering climate changes, geological factors, and human activities, the cardiovascular healthcare providers as part of medical community should be aware of the high rate of cardiovascular disease burden that can occur among survivors of earthquakes and other natural disasters, so, they should act accordingly in terms of preparedness measures, adequate response planning starting from services re-allocation to personnel training and enhancing access to medical and cardiac care in both acute and chronic contexts, not to mention screening and risk-stratifying the patients to optimize their management.

A new door to a different world: opportunities from the metaverse and the raise of meta-medical laboratories.

OBJECTIVES: In the digital age, the metaverse has emerged with impressive potential for many segments of society. The metaverse could be presented as a parallel dimension able to enhance the physical world as well as our actions and decisions in it with the objective to use a coalition between the natural and virtual worlds for value creation. Our aim was to elaborate on the impact of the metaverse on laboratory medicine. METHODS: Based on the available evidence, literature and reports, we analyzed the different perspectives of the metaverse on laboratory medicine and the needs for an efficient transition. RESULTS: The convergence and integration of technologies in the metaverse will participate to the reimagination of laboratory medicine services with augmented services, users' experiences, efficiency, and personalized care. The revolution around the metaverse offers different opportunities for laboratory medicine but also open multiple related challenges that are presented in this article. CONCLUSIONS: Scientific societies, multidisciplinary teams and specialists in laboratory medicine must prepare the integration metaverse and meta-medical laboratories, raise the awareness, educate, set guidance to obtain a maximum of value and mitigate potential adverse consequences.

Assessment of Right Ventricular Systolic Function with 3-Dimensional Speckle Tracking Echocardiography in Isolated Mild Mitral Stenosis.

BACKGROUND: In rheumatic severe mitral stenosis, right ventricular mechanics deteriorate with the increasing severity of mitral stenosis. Therefore, we aimed to investigate right ventricular mechanics in patients with mild mitral stenosis using 3-dimensional speckle tracking echocardiography. METHODS: In total, 40 patients with mild mitral stenosis and 36 age- and gender-matched healthy controls were included. Conventional echocardiographic examination was performed and 3-dimensional data sets were acquired for strain analysis. Besides conventional echocardiographic parameters, right ventricular volume and function and 3-dimensional speckle tracking echocardiography-derived right ventricular free wall longitudinal strain were compared between patients with mild mitral stenosis and healthy controls. RESULTS: Although 3-dimensional right ventricular volumes and ejection fraction were similar between the groups, 3-dimensional speckle tracking echocardiography-derived right ventricular free wall longitudinal strain was significantly lower in patients with mild mitral stenosis than in controls (25.57 ± 4.39% vs. 27.90 ± 4.71%, P =.028). Significant correlations were observed between right ventricular free wall longitudinal strain and mitral valve area and estimated systolic pulmonary artery pressure (r = 0.597, P <.001; r = -0.508, P =.003, respectively). Another significant positive correlation was observed between planimetric mitral valve area and 3-dimensional speckle tracking echocardiography-derived right ventricular free wall longitudinal strain (r = 0.597, P <.001). CONCLUSION: The degree of severity of mild mitral stenosis in terms of mitral valve area can help in the early detection of subclinical right ventricular systolic function impairment which can be easily detected by 3-dimensional speckle tracking echocardiography. Right ventricular contractile performance could decrease even in mild mitral stenosis.

International consensus statement on challenges for women in cardiovascular practice and research in the COVID-19 era.

The challenges to academic and professional development and career advancement of women in cardiology (WIC), imposed by the pandemic, not only impinge the female cardiologists' "leaky pipeline" but also make the "leakiness" more obvious. This consensus document aims to highlight the pandemic challenges WIC face, raise awareness of the gender equity gap, and propose mitigating actionable solutions derived from the data and experiences of an international group of female cardiovascular clinicians and researchers. This changing landscape has led to the need for highly specialized cardiologists who may have additional training in critical care, imaging, advanced heart failure, or interventional cardiology. Although women account for most medical school graduates, the number of WIC, particularly in mentioned sub-specialties, remains low. Moreover, women have been more affected by systemic issues within these challenging work environments, limiting their professional progression, career advancement, and economic potential. Therefore, it is imperative that tangible action points be noted and undertaken to ensure the representation of women in leadership, advocacy, and decision-making, and increase diversity in academia. Strategies to mitigate the negative impacts of the pandemic need to be taken during this COVID-19 pandemic to ensure WIC have a place in the field of Cardiology.

Assessment of sacubitril/valsartan effects on left ventricular dynamics using 3D echocardiography and 3D strain in heart failure with reduced ejection fraction patients.

BACKGROUND: Three-dimensional (3D) echocardiography and 3D strain parameters have been used for a comprehensive quantitative assessment of left ventricular (LV) myocardial dynamics. So far, there are no data on sacubitril/valsartan effects on cardiac functions and LV reverse remodeling using 3D echocardiography. This study aimed to evaluate the effects of sacubitril/valsartan on the LV functions using two-dimensional (2D) echocardiography, 3D echocardiography, and the 3D strain parameters. METHODS: A single-center prospective cohort study which included 100 heart failure with reduced ejection fraction (HFrEF) patients with guidelines-approved indications for sacubitril/valsartan treatment. Patients received a short course (3-month) of sacubitril/valsartan. 3-month follow-up 2D, 3D echocardiographic parameters, and 3D strain were compared to baseline parameters. RESULTS: The results of the study revealed a significant improvement in left ventricular dynamic functions at 3-month follow-up with an improvement in left ventricular systolic function (mean left ventricular ejection fraction (LVEF) increased from 27.65±4.98% to 32.89±6.03%, P<0.001). Comparison of HFrEF patients with ischemic and non-ischemic etiologies showed that echocardiographic parameters significantly improved in both groups after 3 months of sacubitril/valsartan treatment. There was no statistically significant difference between both groups regarding echocardiographic parameters at baseline and 3-month follow-up. CONCLUSIONS: In a single-center prospective observational cohort study evaluating the effects of short-term (3-month course) sacubitril/valsartan treatment on LV dynamics assessed by 3D echocardiography and 3D strain, sacubitril/valsartan was associated with a significant improvement of LV systolic functions and reverse remodeling effects in both ischemic and non-ischemic HFrEF patients.

Effects of Covid-19 fear on the attitudes toward Covid-19 vaccination in reproductive women.

This research aimed to determine the effect of Covid-19 fears on attitudes of women of reproductive age toward Covid-19 vaccination. This descriptive cross-sectional study was conducted with 413 women aged 18-49. "Participant Identification Form," "Fear of Covid-19 Scale (FCV-19S)" and "Attitudes Towards Covid-19 Vaccine Scale (ATV-Covid-19)" were used to collect data. Kruskall Wallis test, Man Whitney U test and Spearman correlation test were used to evaluate the data. The mean FCV-19S total score of the women within the scope of the study was 18.70 ± 5.34. The mean score of the positive attitude sub-dimension of ATV-Covid-19 of women was 14.09 ± 3.80, the mean score of the negative attitude sub-dimension was 16.21 ± 3.26. A positive, weak and statistically significant correlation was found between FCV-19S total score and ATV-Covid-19 positive attitude sub-dimension mean score (p < 0.05). It was determined that the women within the scope of the study had a moderate fear of Covid-19. However, more women had positive than negative attitudes toward Covid-19 vaccines. In addition, as the level of fear of Covid-19 increases, positive attitudes toward the Covid-19 vaccines increase.

A rare case of quadrileaflet mitral valve and ostium primum atrial septal defect.

A 60-year-old woman was referred to our clinic for evaluation of her rapidly progressive dyspnea, and she had no previous history of heart disease. A murmur was noted on her examination, and transthoracic echocardiography was so difficult to be performed due to poor acoustic windows so she was referred to do a transesophageal echocardiography that showed an ostium primum atrial septal defect (ASD) with left-to-right shunt and a quadrileaflet mitral valve with severe regurgitation. Later on, she underwent surgery with ostium primum ASD closure by a patch and double cleft repair by suture after right heart catheterization.

Plasma apelin level in acute myocardial infarction and its relation with prognosis: A prospective study.

OBJECTIVE: Apelin is a novel adipocytokine with a significant role in ischemia/reperfusion injury that is synthesized and secreted in myocardial cells and coronary endothelium. There is debate on its value for the diagnosis and prognosis of myocardial infarction. We aimed to investigate plasma apelin level in patients with acute ST segment elevation (STEMI) and non-ST segment elevation (NSTEMI) myocardial infarction and its relationship with left ventricular function and prognostic parameters. METHODS: Forty-one patients with STEMI, 21 patients with NSTEMI and 10 patients as control group with normal coronary angiograms were included. Plasma apelin level at presentation was investigated regarding its relationship with other diagnostic and prognostic parameters. RESULTS: Apelin level was significantly higher in acute myocardial infarction (0.31 ± 0.56 ng/mL) compared to control group (0.08 ± 0.05 ng/mL) (p < 0.01). Likewise, it was found to be significantly higher in STEMI group (0.45 ± 0.73 ng/mL) compared to control group (0.08 ± 0.05 ng/mL) (p < 0.01). Although apelin was higher in NSTEMI group (0.13 ± 0.10 ng/mL) compared to control group (0.08 ± 0.05 ng/mL), this difference was not statistically significant (p > 0.05). No correlation was found between apelin and NT-proBNP, hsCRP, troponin, ejection fraction (EF) and Killip score (p > 0.05). A positive correlation was found between apelin and TIMI, GRACE and Gensini scores (p < 0.05). Only GRACE score was found to be correlated with apelin in MI groups. CONCLUSION: Apelin level was found to be high in acute myocardial infarction. With its inotropic and vasodilator effects, apelin was thought to have a protective role against severe ischemia.

Speckle tracking echocardiography in severe patient-prosthesis mismatch.

BACKGROUND: Although aortic valve replacement (AVR) when successfully performed boasts low mortality rates in selected patients, prosthesis-patient mismatch (PPM) can be found in the majority of these individuals. Limited research is available supporting the benefit of two-dimensional speckle tracking echocardiography (2D-STE) in patients with severe PPM. This study sought to assess myocardial strain using 2D-STE to determine the relationship between subclinical left ventricular (LV) dysfunction and aortic PPM in patients undergoing AVR with preserved LV ejection fraction. MATERIAL AND METHODS: We retrospectively examined all consecutive patients with isolated AVR who presented to our center from 2005 to 2018. The data of 1086 patients were analyzed. Severe PPM was defined as an indexed effective orifice area of 0.65 cm2/m2 or less. As a result of the detailed assessment, 54 patients meeting the eligibility criteria were included in the study. Baseline data were collected and compared between the two groups of patients with severe PPM (n = 27) and those with normofunctional aortic prosthesis valve as a control group (n = 27). All patients underwent baseline echocardiography. Global longitudinal strain (GLS) and global circumferential strain (GCS) were evaluated by 2D-STE. RESULTS: When compared with controls, patients with severe PPM had significantly decreased GLS (18.6 ± 2.9 vs. 21.4 ± 2.1; p < 0.01) and GCS (17.2 ± 3.6 vs. 21.7 ± 2.1; p < 0.01) values. CONCLUSION: In addition to standard clinical and echocardiographic parameters, GLS and GCS suggest subclinical dysfunction and have incremental value in patients with severe PPM.

Women's perspective on the COVID-19 pandemic: Walking into a post-peak phase.

The pandemic of Novel Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has provoked hundreds of thousands of deaths, resulting in catastrophe for humans. Although some insights have been garnered in studies on women, children and young adults infected with COVID-19, these often remain fragmented in literature. Therefore, we discussed the impact of COVID-19 pandemic on women, children and young patients, particularly those with underlying cardiovascular comorbidities or congenital heart disease. Furthermore, we gathered and distilled the existing body of literature that describes their cardiovascular complications and the recommended actions in favour of those patients toward the post-peak pandemic period. Although many questions still require answers, this article is sought to help the practicing clinician in the understanding and management of the threatening disease in special populations.

A real-life correlation between clinical SYNTAX score II and carotid intima-media thickness in patients with stable coronary artery disease.

BACKGROUND: SYNTAX score II (SSII) is an update of the established SYNTAX score (SS) that uses clinical variables such as age, sex, creatinine clearance, left ventricular ejection fraction, chronic obstructive pulmonary disease, and peripheral arterial disease. Furthermore, SSII has been proven to be a more powerful predictive tool than SS in patients with complex coronary artery disease (CAD). Carotid õntima-media thickness (CIMT) is a widely used noninvasive evidence for subclinical or early atherosclerosis, and it was proved to be an independent predictor for cardiovascular events. Most of the previously published articles studied the association between the CIMT with old cardiovascular scoring systems such as SSI and Gensini score with debatable data about their correlation. AIM: To study the correlation between SSII and CIMT in stable CAD patients undergoing elective coronary angiography (CA). METHOD AND PATIENTS: A prospective study including 155 patients undergoing elective CA for stable CAD excluding patients with history of acute coronary syndrome, previous coronary revascularization either by percutaneous coronary intervention or coronary artery bypass grafting, and previous cerebrovascular stroke. RESULTS: The mean age of patients was 58.25 ± 16.46 years, and 79 patients (50.96%) were men. The mean SSII score was 10.23 ± 11.36 and mean CIMT was 0.85 ± 0.24. The correlation between SSII and CIMT using Spearman correlation showed a strong correlation between SSII score and CIMT with correlation coefficient r = 0.752. CONCLUSION: The study showed a strong positive correlation between SSII and CIMT in stable CAD patients undergoing elective CA.