Randomized comparison of the effects of tailored text messaging versus pillbox organizers on medication adherence of heart failure patients.

BACKGROUND: Heart failure (HF) is a major public health issue worldwide, affecting approximately 64.3 million people in 2017. Non-adherence to medication is a common and serious issue in the management of HF. However, new reminder systems utilizing mobile technology, such as text messaging, have shown promise in improving medication adherence. The purpose of this study was to compare the impact of tailored text messaging (TTM) and pillbox organizers on medication adherence in individuals with HF. METHODS: A randomized controlled trial was conducted, involving 189 eligible patients with HF who were randomly assigned to either the TTM, pillbox organizer, or control group. Medication adherence was evaluated using pill counting and the Medication Adherence Rating Scale (MARS) over a period of three months and compared across the groups. The data were analyzed using Kruskal-Wallis, Analysis of Variance (ANOVA), and Repeated Measures ANOVA tests. RESULTS: The results indicate that both the TTM and pillbox organizers groups had significantly higher medication adherence compared to the control group, as measured by pill counting (MD = 0.05, 95%CI = 0.03-0.06; p < 0.001 for TTM group, MD = 0.04, 95%CI = 0.03-0.06; p < 0.001 for pillbox organizers group) and the MARS (MD = 1.32, 95%CI = 0.93 to 1.72; p < 0.001 for TTM group, MD = 1.33, 95%CI = 0.95 to 1.72; p < 0.001 for pillbox organizers group). However, there was no statistically significant difference in medication adherence between the two intervention groups using either measurement method. The TTM group exhibited a lower hospitalization rate than the other groups in the first follow up (p = 0.016). CONCLUSIONS: Both the TTM and pillbox organizers were shown to be effective in enhancing medication adherence among patients with HF. Therefore, healthcare providers should take into account the patient's condition and preferences when selecting one of these methods to promote medication adherence. Future research should aim to address the limitations of this study, such as controlling for confounding variables, considering long-term effects, and comparing the effectiveness of different interventions.

Comparison of early mobilization protocols on postoperative cognitive dysfunction, pain, and length of hospital stay in patients undergoing coronary artery bypass graft surgery: A randomized controlled trial.

Although coronary artery bypass graft (CABG) surgery improves the life expectancy of patients with coronary artery disease, it is associated with various short and long-term complications. Early mobilization has been shown to reduce the risk of these complications. This study aimed to compare the effectiveness of different early mobilization protocols on postoperative cognitive dysfunction (POCD), pain intensity, and length of hospital stay (LOS) in patients undergoing CABG. This three-arm parallel randomized controlled trial included 120 patients undergoing CABG surgery who were randomly assigned to Intervention A, which received a four-phase early mobilization protocol; Intervention B, which received a three-phase early mobilization protocol; and the Control group, which received routine care. Postoperative cognitive dysfunction and pain were assessed using Mini Mental State Examination (MMSE) and visual analog scale (VAS), respectively. Groups were comparable in demographic and clinical characteristics and postoperative cognitive dysfunction at baseline. After the intervention, Group B had statistically significantly (p < 0.001) less cognitive dysfunction (25.8 ± 1.7) compared to Group A (24.1 ± 2.2) and the Control Group (23.4 ± 2.7). Likewise, hospital stay was statistically (p < 0.01) shorter for Group B (7.7 ± 1.5) than the Control group (8.9 ± 1.9). However, the experience of pain was statistically significantly lower over time in Group A than in the other groups (p < 0.001). This study concludes that an early mobilization protocol based on deep breathing exercises and chest physiotherapy may better improve postoperative cognitive dysfunction and length of hospital stay than an early mobilization protocol based on passive and active range of motion activities or routine care.

Enhancing Cancer Pain Self-Management: A Holistic Supporting Model.

Introduction: Pain self-management is crucial in reducing pain intensity and improving the quality of life for cancer patients. By acquiring self-management skills, patients can actively participate in managing their pain. Objective: The objective of this study was to develop a grounded theory-based model to assist cancer patients in enhancing their pain self-management. Methods: This qualitative research was conducted in two stages from 2019 to 2021. The initial phase utilized a grounded theory approach to explore the process of pain self-management in cancer patients. Following Corbin and Strauss' analytical method, a grounded theory of pain management in cancer patients was identified. Subsequently, Walker and Avant's theory synthesis strategy was employed to construct a practical model that provides support for patients in managing their pain. Results: Within the conceptual framework, this study developed the "Holistic Supporting from Pain Self-Management" model. This supportive model consists of three main components: (1) enhancing pain self-management skills in cancer patients and their families, (2) empowering physicians and nurses in pain management for cancer patients, and (3) improving the organizational structure for pain management in cancer patients. Conclusion: The Holistic Supporting from Pain Self-Management model emphasizes the importance of addressing all dimensions of cancer pain, including physical, functional, psychosocial, cultural, and spiritual aspects, to effectively manage pain in cancer patients. This model addresses the needs of patients, healthcare providers, and the healthcare system, aiming to enhance and support pain self-management.

Illness Perception, Self-Efficacy, and Medication Adherence in Patients With Coronary Artery Disease: A Path Analysis of Conceptual Model.

Introduction: Illness perception and self-efficacy in patients with coronary artery disease (CAD) may affect medication adherence, which is one of the most important challenges in disease management in this group of patients. Objective: The present study aimed to investigate the factors influencing medication adherence in CAD patients, especially the effect of illness perception and self-efficacy. Methods: This study was cross-sectional and conducted from April to September 2021. A total of 259 patients with confirmed CAD were selected by convenience sampling method based on inclusion criteria. Illness perception, self-efficacy, and medication adherence were investigated using Brief IPQ, SCSES, and MARS_10 questionnaires, respectively. The data were analyzed using the STATA software (version 14) and the regression path analysis method. Results: Patients had moderate illness perception and high self-efficacy, and 61.8 of them adhered to their medication regimen. Greater illness perception, better self-efficacy, and higher education had a positive effect on medication adherence, and increasing age had a negative effect on it. The final path model shows a good fit of the data in the model (χ2: 0.37, df: 274, χ2/df: 0.36, CFI: 1, IFI: 0.95, TLI: 1.07, and RMSEA: 0.00). Conclusion: The results of the present study suggest that patients' illness perception can play an important role in predicting self-efficacy in disease management and the level of medication adherence in patients with CAD. To improve self-efficacy and medication adherence, future intervention studies should focus on the patient's illness perceptions and their improvement.

Pain Self-management Strategies in Patients With Cancer: A Qualitative Study.

Successful pain management in patients with cancer is a significant challenge, and paying more attention to patients' experiences of pain self-management strategies has particular importance. This study aimed to explore pain self-management strategies in Iranian patients with cancer. This qualitative study was conducted on 14 patients with cancer. Data were collected using semistructured interviews and analyzed through the Graneheim and Lundman content analysis approach. Two main categories emerged from data analysis: (1) psychological pain self-management strategies, and (2) behavioral pain self-management strategies. Psychological strategies included pain distraction techniques, spiritual tendencies, increasing social interactions and support networks, pain tolerance and self-control, and resistance to pain. Behavioral strategies included massage and touch, heat and cold therapy, opium (Taryak in Persian) and tobacco use, herbal and home remedies, and proper diet.

Effects of early mobilization on pulmonary parameters and complications post coronary artery bypass graft surgery.

This study compared the effects of a four-phase and a three-phase early mobilization protocol on respiratory parameters and complications in patients following coronary artery bypass graft surgery. This is a three-arm, parallel-group, randomized controlled clinical trial with 120 candidates for coronary artery bypass graft surgery. Participants were randomly allocated to three groups: four-phase early mobilization protocol, three-phase early mobilization protocol, and control. Arterial blood gases, oxygen saturation, and incidence of pulmonary complications were compared among the groups. Mean arterial blood gases and oxygen saturation improved significantly over time in both four-phase early mobilization protocol and three-phase early mobilization protocol groups compared to control (p < 0.05). There were observed trends for greater improvements in the study outcomes with three-phase early mobilization protocol than four-phase early mobilization protocol; however, did not reach statistically significant levels. The incidence of pulmonary complications was significantly in both intervention groups compared to control (odds ratio: 0.48, 95 % CI 0.007-0.537; p < 0.001). Both four-phase early mobilization and the three-phase early mobilization protocols improved respiratory parameters and reduced pulmonary complications. Statistically insignificant trends were found trends in the three-phase early mobilization protocol, focusing on chest physiotherapy and breathing exercises.

Illness acceptance, medication adherence and the quality of life in patients with heart failure: A path analysis of a conceptual model.

Heart failure (HF) is a chronic disease that negatively affects different aspects of the patients' lives, diminishing their quality of life. This research studied factors that impact the health-related quality of life (HRQoL) of patients with HF, particularly medication adherence and acceptance of illness. In this cross-sectional study, data were collected from 273 patients admitted to a tertiary hospital with the diagnosis of HF. Participants' level of illness acceptance, medication adherence, and HRQoL were assessed using validated questionnaires, and data were analyzed using the regression path analysis. There was found a moderate level of acceptance of illness (24.9 ± 6.79) and low levels of medication adherence (3.44 ± 3.15) and HRQoL (53.81 ± 17.99) among participants. Gender, education, income, history of coronary artery bypass (CABG), the New York Heart Association (NYHA) class, acceptance of illness, and medication adherence were statistically significantly associated with HRQoL. Patients with diminished HRQoL were more likely to be female, less educated, have lower income, higher NYHA class, no prior CABG, low medication adherence, and low level of acceptance of illness. The final path model demonstrated a good fit with the data (χ^2/df = 1.70, CFI = 0.92, RMSEA = 0.05, and p = 0.01). Health care providers should target and promote medication adherence and the acceptance of illness as modifiable factors to help improve the HRQoL of patients with HF.

Barriers to cancer pain management from the perspective of patients: A qualitative study.

AIM: The aim of this study was to explore the barriers to effective pain management in Iranian people with cancer. DESIGN: A qualitative descriptive design was used. METHODS: This qualitative descriptive study was performed on 14 people with cancer. Data were collected using semi-structured interviews and analysed by Graneheim and Lundman's content analysis method. RESULTS: Four main categories emerged in relation to barriers to pain management from the perspective of people with cancer. Categories included 1) accepting and enduring divine pain, 2) negative attitudes towards the effectiveness of analgesics, 3) patients' low knowledge of pain self-management methods and 4) neglected pain management. Barriers to pain management are multidimensional in nature consisting of patients, healthcare providers and system components. Therefore, attempts should be focused on the education of patients and healthcare providers about pain management and eliminating the shortcomings of the healthcare system.

Nurses' use of non-pharmacological pain management methods in intensive care units: A descriptive cross-sectional study.

BACKGROUND: Pain is a common and unpleasant feeling among patients in intensive care units. Therefore, the use of proper pain management methods, such as non-pharmacological interventions, is a priority in intensive care units. OBJECTIVE: This study aimed to ascertain the extent of the use of non-pharmacological pain management methods by intensive care unit nurses in Iran and to identify the obstacles that hindered the use of these methods. MATERIAL AND METHODS: This study used a descriptive cross-sectional design which involved a convenience sample of 224 nurses who worked in 16 intensive care units across northern Iran. Data were collected using the non-pharmacological pain management questionnaire and a researcher-developed checklist of the obstacles that hindered the use of non-pharmacological pain management methods. RESULTS: A moderate number of ICU nurses used non-pharmacological pain management methods (55.8 %). The most common method used by nurses was repositioning (M = 2.72), while methods such as acupuncture and reflexology were used less frequently. Furthermore, the most common obstacles to the use of non-pharmacological pain management methods were nurses' fatigue (M = 2.92) and multiple responsibilities (M = 2.91). Demographic variables such as age, gender, educational level, and work experience were not significantly associated with the use of non-pharmacological pain management methods. CONCLUSIONS: Due to factors such as fatigue, multiple responsibilities, a heavy workload, and an insufficient number of nurses per shift, the rate of utilization of non-pharmacological pain management methods among intensive care unit nurses in Iran was low. Furthermore, most of the participants in this study had not attended courses on non-pharmacological pain management.

Evaluation of growth factor independence 1 expression in patients with de novo acute myeloid leukemia.

OBJECTIVE: Growth factor independence 1 (GFI1), a transcriptional repressor, is required for hematopoietic stem cell maintenance and self-renewal in addition to controlling differentiation and proliferation of myeloid cells. As murine studies have demonstrated that this transcription factor has a notable role in the initiation and progression of acute myeloid leukemia (AML) disease, the aim of the current study was to investigate and review the influence of GFI1 in human AML cells. METHODS: GFI1 expression levels were measured by means of real-time polymerase chain reaction in 96 primary AML samples which were then compared to gene expression levels observed in 18 healthy subjects. Moreover, GFI1 expression patterns were analyzed based on specific AML subtypes including acute promyelocytic leukemia (APL). Finally, leukemic cells were stained to measure levels of myeloperoxidase (MPO) activity. RESULTS: This study reports that AML patients have significantly higher GFI1 mRNA levels in comparison to healthy subjects and that, when considering AML subtypes, patients with APL have higher GFI1 expression than non-APL patients. CONCLUSION: It is also concluded that GFI1 overexpression in patients with high MPO levels, such as those of the APL subtype, is correlated with favorable disease prognosis as supported by other studies which demonstrate that increased peroxide activity and GFI1 are independently correlated with a favorable prognosis.

Comparison of the effects of debriefing methods on psychomotor skills, self-confidence, and satisfaction in novice nursing students: A quasi-experimental study.

Oral debriefing (OD) and video-assisted debriefing (VAD) are commonly used debriefing methods, with no evidence of superiority of one to another. The present study aimed to compare the effects of OD and VAD on the development of learning outcomes in nursing students. This is a quasi-experimental study. A total of 50 first-year nursing students participated in this study. Participants in the control group participated in OD and those in the intervention group took part in VAD. Debriefing improved psychomotor skills, self-confidence, and student satisfaction in both groups. There was no statistically significant difference between OD and VAD in the study outcomes. Both OD and VAD methods have significantly positive impact on simulation outcomes and can increase preparedness of nursing students before entering the clinical settings. Given the widespread use of simulation, more studies are needed to evaluate different methods of debriefing to optimize the usefulness of simulation-based learning.

Effects of foot reflexology on anxiety and physiological parameters in patients undergoing coronary artery bypass graft surgery: A clinical trial.

INTRODUCTION: This study aimed to investigate the effect of foot reflexology on anxiety and physiological parameters in patients after CABG surgery. METHOD: This was a single-blind, three-arm, parallel-group, randomized controlled trial with three groups of 40 male patients undergoing CABG. Participants were placed in three groups, named intervention, placebo, and control. Physiological parameters were measured including systolic and diastolic blood pressure, mean arterial pressure, heart rate, respiratory rate, percutaneous oxygen saturation, and anxiety of participants. RESULTS: Results showed a statistically significant difference between intervention and control groups in terms of the level of anxiety (p < 0.05). Also, results showed a statistically significant effect on all physiological parameters except heart rate (p < 0.05). CONCLUSION: This study indicated that foot reflexology may be used by nurses as an adjunct to standard ICU care to reduce anxiety and stabilize physiological parameters such as systolic, diastolic, mean arterial pressure, and heart rate.

Unmet Supportive Care Needs of Iranian Cancer Patients and its Related Factors.

Introduction: Investigation of supportive care needs of cancer patients is important to implement any supportive care programs. There is no relevant studies investigated supportive care needs of Iranian cancer patients and factors affecting such needs. So, the aims of present study were to determine the unmet supportive care needs of Iranian cancer patients and its predictive factors. Methods: In this descriptive- correlational study 274 cancer patients in one referral medical center in North West of Iran participated. For data collection, demographic and cancer related information checklist and Supportive Care Needs Survey (SCNS) was used. Logistic regression was used for data analysis of un-adjusted and adjusted Odds Ratios (ORs) for patients needs and analysis of variables of study based on Backward LR procedure SPSS Ver.13. Results: More than fifty percent of participants reported unmet needs in 18 items of SCNS. Most frequent unmet needs were related to health system and information domains and most meet needs were related to sexuality and psychological domains. The result of logistic regression identified predictors of each domain of supportive care needs. The variable such as sex, age and living situation were most important predictors of unmet needs. Conclusion: The results showed that Iranian cancer patients have many supportive care needs in different domains. In general female cancer patients are at risk of more unmet supportive care needs. So, health care professionals should be more sensitive to fulfillment of supportive care needs of female.

The lived experiences of patients post coronary angioplasty: a qualitative study.

Few qualitative studies have focused on the experiences of patients post angioplasty. A deep understanding of patient experiences of care and the way a treatment can affect their everyday life is particularly important in chronic disease management. The aim of this study was to explore experiences that patients undergo after angioplasty. Using a phenomenological study design, 15 patients participated in individual, face-to-face, semistructured interviews. Data were analyzed using qualitative content analysis. The following core themes emerged from the analysis, which reflect the experiences of patients post angioplasty: (a) Angioplasty is a milestone in the patient's life, (b) living with a mended heart, and (c) psychological distress as an integral part of the patient's life. Participants after angioplasty went through both positive and negative changes in their life. Understanding these experiences is essential to modifying high-risk behaviors while supporting patients through their rehabilitation.

Gestational surrogacy: Viewpoint of Iranian infertile women.

BACKGROUND: Surrogacy is a popular form of assisted reproductive technology of which only gestational form is approved by most of the religious scholars in Iran. Little evidence exists about the Iranian infertile women's viewpoint regarding gestational surrogacy. AIM: To assess the viewpoint of Iranian infertile women toward gestational surrogacy. SETTING AND DESIGN: This descriptive study was conducted at the infertility clinic of Tabriz University of Medical Sciences, Iran. MATERIALS AND METHODS: The study sample consisted of 238 infertile women who were selected using the eligible sampling method. Data were collected by using a researcher developed questionnaire that included 25 items based on a five-point Likert scale. STATISTICAL ANALYSIS: Data analysis was conducted by SPSS statistical software using descriptive statistics. RESULTS: Viewpoint of 214 women (89.9%) was positive. 36 (15.1%) women considered gestational surrogacy against their religious beliefs; 170 women (71.4%) did not assume the commissioning couple as owners of the baby; 160 women (67.2%) said that children who were born through surrogacy would better not know about it; and 174 women (73.1%) believed that children born through surrogacy will face mental problems. CONCLUSION: Iranian infertile women have positive viewpoint regarding the surrogacy. However, to increase the acceptability of surrogacy among infertile women, further efforts are needed.