بابک منافی

Non-adherence to treatment increases complications and mortality after myocardial infarction. The present study aimed to assess the effect of education and telephone follow-up on patients' adherence to the treatment regimen after myocardial infarction.

This clinical trial study was performed on of 150 patients who were selected via convenience sampling method and assigned to three groups: control, intervention 1 (face-to-face training based on the training booklet), and intervention 2 (face-to-face training and follow-up telephone care). Patients in intervention group 2 were followed up by telephone for three months. Data were collected based on a questionnaire of adherence to the treatment regimen and demographic. Data analysis was performed in SPSS software (version 21) using ANOVA, Chi-square, Fisher, and Repeated Measures ANOVA.

The mean score of adherence at the beginning of the study was 64.60±8.13 (P<0.001). The mean score of adherence to treatment in all three groups was increased 1.5 months after the intervention; nonetheless, it was higher in intervention group 1 (face-to-face training) than that in other groups (81.69±5.12) (P<0.001). Three months after the intervention, the mean of adherence to treatment in intervention group 2 (face-to-face training and telephone follow-up) was higher than that in other groups (87.94±4.04) (P<0.001). During the three stages, no statistically significant difference was observed between the two methods of telephone follow-up and education alone (P=0.710).

Education with and without telephone follow-up leads to improved adherence to treatment; therefore, one of the two educational methods can be selected to increase patients' adherence to the treatment regimen.

Nowadays, the use of lasers in welding titanium alloys has special applications in high-tech industries. This study aims to extract the statistical model showing the effect of changes in the diameter of laser beam diameter and distance in line thickness welding temperature. At first, For establishing this model, the required experiments were designed by the Taguchi method and then evaluated using the finite element method. The surface response method is used to extract the statistical model based on the variation of laser beam diameter and distance through the workpiece thickness. By the analysis of the variance, the statistical model error was evaluated in an acceptable range. According to the evaluated results, the influence percent of the distance along with the workpiece thickness and the laser beam diameter is 76.67 and 97 %, respectively, on the welding temperature. By increasing the diameter of the laser beam, the amount of the welding temperature is significantly reduced. For laser welding of Ti6Al4V, the best laser beam diameter is between 0.2 and 0.24mm.

The previous studies showed that there are different models of foot in terms of appearance and size of the toes, including Egyptian, Roman, Greek, Semi-Roman, and square feet. But no information is available on the features of the Iranian foot. The purpose of the current study was to obtain the Iranian foot model using statistical and image analysis methods to determine whether the Iranian foot model adheres to the previous models or develops a new one.

In the current study, eight Pedoscope devices were provided and sent to eight provinces of the country to obtain images of the foot shape. The Cochran method was used to estimate the sample size. The sampling method used was the random cluster and the optimal probability accuracy was considered to be 0.05. In the Cochran relation, the p-value was 0.5. Statistical calculations were performed using Cochran's formula (for the left and right feet) of 385 men and women. Image J software was used to analyze the images and to determine the characteristics of the foot models.

The largest model in the female community was the Egyptian model, which covers 39.5% of the female population. After that, the Semi-Roman model was the most prevalent covering 33% of the female population. In the study of men's society, the Semi-Roman and Egyptian foot models cover 43.59% and 42.92% of community, respectively.

The two Egyptian and Semi-Roman models are the two common foot models in Iranians that cover about 86% of the male population and more than 70 % of the female population in this study. Due to the predominance of the Egyptian foot shape, diseases such as Onychocryptosis are common among Iranians.

Hospitalization in Intensive Care Units (ICU) causes sleep and comfort disturbances in patients and has an adverse effect on the recovery process of these patients. One of the factors affecting sleep and comfort of patients is ambient noise. This study aimed to determine the effect of the white noise on sleep quality and comfort of patients.

The present study was a randomized, double-blind clinical trial with 60 patients undergoing open heart surgery who had admitted in the ICU in Hamadan in 2018.Patients in the experimental group selected one of the three sounds of rain, sea and river waves and played them with headphones for three nights for 20-30 minutes. The control group did not receive any intervention. The sleep quality of patients was measured using standard St Marychr('39')s Hospital Sleep Quality Questionnaires and VAS.  

The results showed that there were no differences in demographic and clinical characteristics (nausea, medications, type of surgery, length of stay, duration of surgery) in the control and experimental groups. The results also showed that using white noise significantly reduces sleep disturbance and increases comfort in the experimental group compared to the control group (P <0.001).

The use of white noise such as the sound of sea waves, river sound and rain in ICU patients after open heart surgery reduces their sleep disturbance and increases their comfort.

Shoes are used in daily activities to protect the human foot against applied forces from the ground. One of the most important parts of shoes which absorb the incoming forces is the outsole. The aim of the present research is to investigate the efficiency of three different materials in fabricating outsoles. Outsoles made of styrene butadiene rubber (SBR), polyurethane (PU), and polyvinyl chloride (PVC) were fabricated with the same geometry and without shoe treads. Then, they were tested by the PEDAR system in order to determine the plantar pressure exerted by each outsole, and they were also tested in terms of fatigue, hardness, and uniaxial compression tests, and after the modeling they were analyzed by finite element method (FEM) software. In static and dynamic states, the outsole made of PVC, SBR, and PU reduces the pressure by 44%, 65%, and 59%, respectively on average compared to barefoot posture. SBR in stress (in static and dynamic states) and strain (in static and dynamic states) have 39.06% and 98.75% better performance on average respectively compared to PVC. In addition, SBR outperformed PU in stress (in static and dynamic states) and strain (in static and dynamic states) by 3.45% and 8.5% respectively. To fabricate outsoles, multilayer outsoles should be used in order to concurrently benefit from the positive characteristics of several materials.

Percutaneous subclavian vein catheterization is one of the most common invasive procedures performed in cardiac surgery. The aim of this study was to compare left and right subclavian vein catheter placement via the infraclavicular approach in patients undergoing coronary artery bypass graft surgery.

This prospective, randomized clinical trial was performed in 193 patients. The technique of cannulation was the same for both the right and the left sides included infraclavicular approach. If catheterization of the subclavian vein was unsuccessful after 2 attempts,the other side subclavian vein was attempted. The success and complication rates were compared in both sides.

In 193 patients, catheterization attempts were performed, in whom 177catheterizations (91.7%) were successful during the first attempt, 105 (92.1%) on the right side and 72 (91.1%) on the left side. There were no significant differences between success rate and side of catheterization. Malposition of the catheter tip on the right side (9.6%) was significantly more(p =0.003) than the left side (0%). There were no significant differences between the incidence of the other complications on the two sides.

Compared with the right side, insertion of the cannula on the left side resulted fewer catheter tip misplacements although both sides showed the same incidence of cannulation failures and other complications.

An overview of the statistics published by various international organizations in various fields of health risk assessment، shows that medical errors (errors in diagnosis، prescription، treatment)، and system management in hospitals and medical centers have important roles in imposition of high costs and increasing rates of injury and death in the world. Heart disease، as the leading cause of death in industrialized countries and the second leading cause of death in Iran has always been a controversial topic for researchers in the treatment area. Due to the potential risk of this area، the occurrence of any error even small errors is a big risk that could ultimately endanger patients'' lives and incur costs to patients and hospitals. This paper attempted to identify، classify and evaluate the failures in open heart surgery using Healthcare Failure Mode and effect analysis (HFMEA) technique and present some solutions in order to control and reduce these failures. U sing the HFMEA، the open heart surgery process was reviewed and four processes، 22 sub-processes، and 82 activities، and 160 risks for these activities were extracted. Besides، the reasons of failures were determined and four failure modes were identified as the most important ones using qualitative and quantitative analysis and solutions were presented for them. Incomplete visit and injury of the saphenous nerve were extracted as the failure modes occurred due to inattention of examiner and incomplete examination and similarity of saphenous nerve and vessel causes injury of the saphenous. Tariff changes and the maneuvers of the second evaluator were proposed strategies to reduce failures mentioned before. Also wrong adaption of coronary with angiography and wrong estimation of the vessels length were two other identified failure modes. The lack of accurate angiography interpretation and carelessness of the surgeon and surgeon assisting in measuring the vessel’s length were the root causes of failures، respectively. Solutions such as performing angiography in multiple views and in a three-dimensional way (3D)، and also measuring the length of vessel using angiography were suggested solutions to reduce these failures. In open-heart surgery، such as inaccurate documentation، inadequate patient justification and lack of modern facilities to identify the precise and explicit situation seems obvious factors.

Platelet activation and aggregation plays an essential role in the for-mation of coronary artery thrombosis. Nowadays, the Clopidogrel is administered oral-ly as an inhibitor of platelet aggregation. Due to the high price of the original brand of Clopidogrel (Plavix), an Iranian brand of Clopidogrel (Osvix) has been produced. This study was conducted to evaluate the effectiveness, side effects and acceptability of lo-cally available brand of Osvix as anti platelet tablet in coronary artery bypass grafting patients in comparison to the original brand (Plavix) by means of platelet aggregation indexes. This clinical study, was conducted at Heart Center of Ekbatan university Hospital in Hamadan in October 2011 to May 2012. In this study 80 patients undergo-ing coronary artery bypass grafting (CABG) were participated in two independent treatment groups. One group used the Iranian brand of Osvix and other one used the original brand (Plavix) as an inhibitor of platelet aggregation. To evaluate the effective-ness of these two in-inhibiting platelets regimens, blood samples were taken from the patients and platelet aggregation test was performed using Helena Biosiences Europe, PACKS4 aggrigometry system (made in France). Mean platelet-rich plasma amount for the Osvix and Plavix treatment group was 236.260 and 153.290 plt/µl respectively. Results showed a statistically significant difference in the rate of platelet-rich plasma by two above mentioned treatment groups. There was no observed statistical difference in side effects of two studied treatment groups. It must be noted that the effectiveness of Plavix tablet regimen as a platelet aggregation inhibitor in patients undergoing CABG was higher than the Osvix tablet treatment regimen. This study showed the Iranian brand of Clopidogrel (Osvix) is significantly different from the original brand (Plavix) in terms of performance factors in preventing platelet aggregation in patients undergoing coronary artery bypass grafting.