Arya Atherosclerosis
Volume:14 Issue: 3, May 2018

The theory-practice gap is one of the important challenges of treatment, health, and educational systems. It is affected by different factors like students, teachers, and the clinical environment. This gap has consequences for education, as well as the treatment and health services systems. Thus, it is necessary to find effective strategies to reduce it. Therefore, the present study was conducted with the aim to find strategies to reduce the theory-practice gap in emergency nursing education in the view of stakeholders.
A qualitative research was conducted, including 18 semi-structured interviews and 3 focus group sessions with the stakeholders in a school of nursing and an educational hospital. Content analysis method was used to analyze the collected data.
The strategies to reduce the theory-practice gap in emergency nursing education were divided into 6 primary categories, 2 main categories and 1 theme of action to change. From among the 69 strategies presented to the focus groups, the participants acknowledged 28 strategies as practical and effective. Furthermore, the participants held that it was necessary to have reformative and developmental actions in line with care, supervision, evaluation, and educational processes in order to reduce the gap between theory and practice in emergency nursing education.
The theory-practice gap is affected by many different factors. Thus, the people involved must pay attention to every influential factor in order to reduce the consequences, and use effective cooperative strategies by taking into consideration the human resources, infrastructures, processes, and the administrative culture in faculty and clinical environments.

Recent studies examining the association between sleep duration and cardiovascular disease (CVD) showed inconsistent results. The aim of our study was to evaluate the association between self-reported night sleep duration and ischemic changes in electrocardiography (ECG).
We conducted this cross-sectional study on 3513 participants from Iranian middle-aged population as a part of Isfahan Healthy Heart Program (IHHP), Isfahan, Iran. Sleep duration was obtained by questioning participants. The frequency of electrocardiographic ischemic changes was calculated using ECG Minnesota coding system.
Short sleep duration was associated with increased frequency of electrocardiographic ischemic changes. In a fully adjusted multiple logistic regression analysis, the odds ratio (OR) for short sleep duration less than 5 hours per night was 1.501 [95% confidence interval (CI) for OR: 1.085-2.076] compared to 8 hours of sleep. After stratifying the study population into sex groups, the association remained significant only in women. The OR for short sleep less than 5 hours per night was 1.565 (95% CI for OR: 1.052-2.329) and 1.455 (95% CI for OR: 0.833-2.539) in women and men, respectively. There was no association between long sleep duration and electrocardiographic ischemic changes in men and women.
We concluded that there is a positive association between short sleep duration and frequency of electrocardiographic ischemic changes in middle-aged women. This association suggests that short sleep duration may increase the risk of ischemic heart disease (IHD) in women, and this need to be evaluated in further studies.

Interleukin-18 (IL-18) is an inflammatory marker with challenging role in atherosclerosis. The present study was carried out aiming to evaluate the association between IL-18 serum level and extent and severity of atherosclerosis among young patients with unstable angina (UA) who underwent coronary angiography.
This cross sectional study was performed from July to October 2015 in Chamran heart center, Isfahan, Iran. 180 patients with UA in the age range of below 50 years entered the study. All demographic, past history, physical examination, electrocardiogram (EKG or ECG), and transthoracic echocardiogram (TTE) data were collected. Serum level of IL-18 was measured using enzyme-linked immunosorbent assay (ELISA) method. A coronary angiography was performed on all patients to evaluate the presence and the incidence rate of coronary artery disease (CAD).
Mean age of the patients was 46.0 ± 4.6 years [47.4 ± 4.3 and 45.9 ± 4.9 among patients with CAD and normal coronary, respectively (P = 0.040)]. Rate of severe CAD was greater among men compared to women with values 67.8% and 51.8%, respectively (P = 0.032). The median [interquartile range (IQR)] value of serum IL-18 among patients with CAD [192.86 (128.03,325.75)] was higher than normal coronary subjects [172.81 (139.77,243.21)], however it was not significant (198.4 ± 93.5, P = 0.287). A significant difference between serum IL-18 level and number of stenosis vessels was detected only among women (P = 0.032).
Serum IL-18 level can predict the number of coronary arteries with significant stenosis among women with unstable angina.

Transulnar approach was introduced as an alternative procedure for transradial coronary angiography (CAG) due to its safety and feasibility. The present study was accomplished with the aim to compare major and minor complications of these two upper extremity approaches in the population under study.
In this prospective observational study, 216 patients who underwent CAG and/or angioplasty via radial (111 cases) or ulnar artery (105 cases) were observed and followed for 6 months and were evaluated for major adverse cardiac events (MACEs), minor and major neurovascular events (access related) of the arm including paresthesia/pain, pseudoaneurysm, artery spasm, arterial occlusion, large hematoma, and necessity for amputation or emergency surgery.
The majority of patients were men (62.1%) with a mean age of 59.98 ± 9.74 years old. No MACEs and major life threatening vascular complication like large hematoma, need for amputation or surgery, and hand ischemia were occurred. There was no significant difference in minor complications, except for arterial occlusion 9.0 % vs 1.0 % and artery spasm 12.6 % vs 1.9 % in transradial and transulnar approaches, respectively (P This study suggested that both transradial and transulnar approaches were safe and feasible for CAG and/or angioplasty. However, regarding minor complications, arterial spasm and occlusion were significantly more common in transradial approach.

Hypertension is a common risk factor for developing cardiovascular, brain, and kidney disorders; and today, it affects about one billion people worldwide. Insufficient clinical knowledge of the practitioners and family physicians and not following the guidelines has led to the improper control of hypertension. This study intended to investigate the knowledge, attitude, and practice of general practitioners (GPs) about hypertension in Hormozgan province, Iran.
This cross-sectional study used consecutive sampling method. A three-part researcher-made questionnaire was used to collect data on demographic, attitude, knowledge, and practice information from 220 GPs working in Hormozgan province.
The mean and standard deviation (SD) of scores on knowledge, practice, and attitude of GPs about hypertension management were (5.00 ± 0.50), (10.00 ± 0.02) and (9.00 ± 0.15), respectively; which present a proper state. Attending training courses and increased work experience have statistically significant effects on the knowledge and attitude of GPs (P The results of this study can be utilized by decision-makers and general medicine curriculum designers to plan effective training courses for medical graduates to be used in clinical settings for health promotions.

Trans-septal puncture (TSP) is a safe and effective method to approach left atrium and ventricle. Nowadays, cardiac electrophysiologists perform this procedure routinely to treat left-sided arrhythmias.
CASE REPORT: A 45-year-old man was referred to our center due to Wolff-Parkinson-White (WPW) syndrome. After trans-septal puncture, contrast injection into the sheath showed that it was in the left ventricle (LV) rather than left atrium. Trans-esophageal echocardiography confirmed left ventricle outflow tract to right atrial (RA) jet. Follow-up echocardiography showed that the tract was present up to 18 months, but considering that the patient was asymptomatic, endovascular or surgical closure was not done.
Our case with an 18-month follow-up period, highlights the conservative approach in asymptomatic patients with this complication.

We report an unusual visceral complication of intra-aortic balloon pump (IABP) due to the malpositioning of the catheter in the aorta.
CASE REPORT: A 55-year-old man with severe left ventricular dysfunction underwent coronary artery bypass grafting (CABG) with the preoperative use of an intra-aortic balloon pump. Postoperative course was complicated by renal and hepatic failure. The early occurrence of complications during 36 hours after operation exhibited a serious vascular complication. The combination of acute renal and hepatic failure led to the suspension to occlusive effect of intra-aortic balloon pump catheter on ostium of the aforementioned organs. The intra-aortic balloon pump was removed, and urine output immediately restored. Thereafter, daily slop dawn serum levels of aminotransferases were started, and became normal at the 10th day of operation.
This is an exceptional case that shows how intra-aortic balloon pump may be contributed to mechanical aortic side branches obstruction. A high index of suspension is mandatory in the diagnosis of such bizarre complications.