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Purpose To retrospectively validate a first-pass analysis (FPA) technique that combines computed tomographic (CT) angiography and dynamic CT perfusion measurement into one low-dose examination. Materials and Methods The study was approved by the animal care committee. The FPA technique was retrospectively validated in six swine (mean weight, 37.3 kg ± 7.5 [standard deviation]) between April 2015 and October 2016. Four to five intermediate-severity stenoses were generated in the left anterior descending artery (LAD), and 20 contrast material-enhanced volume scans were acquired per stenosis. All volume scans were used for maximum slope model (MSM) perfusion measurement, but only two volume scans were used for FPA perfusion measurement. Perfusion measurements in the LAD, left circumflex artery (LCx), right coronary artery, and all three coronary arteries combined were compared with microsphere perfusion measurements by using regression, root-mean-square error, root-mean-square deviation, Lin concordance correlation, and diagnostic outcomes analysis. The CT dose index and size-specific dose estimate per two-volume FPA perfusion measurement were also determined. Results FPA and MSM perfusion measurements (PFPA and PMSM) in all three coronary arteries combined were related to reference standard microsphere perfusion measurements (PMICRO), as follows: PFPA_COMBINED = 1.02 PMICRO_COMBINED + 0.11 (r = 0.96) and PMSM_COMBINED = 0.28 PMICRO_COMBINED + 0.23 (r = 0.89). The CT dose index and size-specific dose estimate per two-volume FPA perfusion measurement were 10.8 and 17.8 mGy, respectively. Conclusion The FPA technique was retrospectively validated in a swine model and has the potential to be used for accurate, low-dose vessel-specific morphologic and physiologic assessment of coronary artery disease. © RSNA, 2017.

Computed tomographic (CT) angiography is an important tool for the evaluation of coronary artery disease but often correlates poorly with myocardial ischemia. Current dynamic CT perfusion techniques can assess ischemia but have limited accuracy and deliver high radiation dose. Therefore, an accurate, low-dose, dynamic CT perfusion technique is needed. A total of 20 contrast-enhanced CT volume scans were acquired in 5 swine (40±10 kg) to generate CT angiography and perfusion images. Varying degrees of stenosis were induced using a balloon catheter in the proximal left anterior descending coronary artery, and a pressure wire was used for reference fractional flow reserve (FFR) measurement. Perfusion measurements were made with only 2 volume scans using a new first-pass analysis (FPA) technique and with 20 volume scans using an existing maximum slope model (MSM) technique. Perfusion (P) and FFR measurements were related by PFPA=1.01 FFR-0.03 (R2=0.85) and PMSM=1.03 FFR-0.03 (R2=0.80) for FPA and MSM techniques, respectively. Additionally, the effective radiation doses were calculated to be 2.64 and 26.4 mSv for FPA and MSM techniques, respectively. A new FPA-based dynamic CT perfusion technique was validated in a swine animal model. The results indicate that the FPA technique can potentially be used for improved anatomical and functional assessment of coronary artery disease at a relatively low radiation dose.

BackgroundEarly discussions about advance care planning (ACP) have been associated with improved patient and caregiver outcomes for patients with serious illness. Many patients with heart failure (HF) may benefit from more timely ACP, in part due to the unpredictable trajectory of the disease.ObjectivesThe purpose of this study was to evaluate the feasibility of implementing a multiple-component hospital-based intervention on completion of ACP forms among HF patients.MethodsA brief hospital-based ACP intervention was led by a nonclinician health educator that included (1) an educational video about shared decision making and (2) a protocol to engage HF providers in patients' ACP decision making after the hospitalization. We surveyed patients regarding attitudes toward the ACP intervention and studied completion rates of advance directives (ADs) or physician orders for life sustaining treatment (POLST) forms six months following discharge.ResultsThe educational video component of this intervention was considered helpful by 92% of participants, and 70% said they were more likely to talk with their physician about their end-of-life preferences after watching the video and interacting with the health educator. Of 37 participants, 49% had evidence of completion of an AD or POLST in their medical records six months after the index hospitalization compared to 32% before the intervention. The number of patients having a signed scanned POLST form increased from 10 (27%) before the intervention to 16 (43%) six months after the intervention (p = 0.03).ConclusionsA hospital-based ACP intervention using nonclinician health educators is feasible to implement and has the potential to facilitate the ACP process.

ImportanceIt remains unclear whether telemonitoring approaches provide benefits for patients with heart failure (HF) after hospitalization.ObjectiveTo evaluate the effectiveness of a care transition intervention using remote patient monitoring in reducing 180-day all-cause readmissions among a broad population of older adults hospitalized with HF.Design, setting, and participantsWe randomized 1437 patients hospitalized for HF between October 12, 2011, and September 30, 2013, to the intervention arm (715 patients) or to the usual care arm (722 patients) of the Better Effectiveness After Transition-Heart Failure (BEAT-HF) study and observed them for 180 days. The dates of our study analysis were March 30, 2014, to October 1, 2015. The setting was 6 academic medical centers in California. Participants were hospitalized individuals 50 years or older who received active treatment for decompensated HF.InterventionsThe intervention combined health coaching telephone calls and telemonitoring. Telemonitoring used electronic equipment that collected daily information about blood pressure, heart rate, symptoms, and weight. Centralized registered nurses conducted telemonitoring reviews, protocolized actions, and telephone calls.Main outcomes and measuresThe primary outcome was readmission for any cause within 180 days after discharge. Secondary outcomes were all-cause readmission within 30 days, all-cause mortality at 30 and 180 days, and quality of life at 30 and 180 days.ResultsAmong 1437 participants, the median age was 73 years. Overall, 46.2% (664 of 1437) were female, and 22.0% (316 of 1437) were African American. The intervention and usual care groups did not differ significantly in readmissions for any cause 180 days after discharge, which occurred in 50.8% (363 of 715) and 49.2% (355 of 722) of patients, respectively (adjusted hazard ratio, 1.03; 95% CI, 0.88-1.20; P = .74). In secondary analyses, there were no significant differences in 30-day readmission or 180-day mortality, but there was a significant difference in 180-day quality of life between the intervention and usual care groups. No adverse events were reported.Conclusions and relevanceAmong patients hospitalized for HF, combined health coaching telephone calls and telemonitoring did not reduce 180-day readmissions.Trial registrationclinicaltrials.gov Identifier: NCT01360203.

Introduction: Chronic inflammation is one of the underlying causes of cardiovascular disease which is commonly seen in patients with chronic kidney disease (CKD) and especially in end-stage renal disease (ESRD), as well as the patients on stable dialysis. Hemodialysis patients suffer from high mortality due to cardiovascular diseases. Objectives: Therefore, the present study aimed to evaluate the effect of atorvastatin and aspirin on C-reactive protein (CRP) concentration in hemodialysis patients and compare the effect of these two drugs on CRP concentration in these patients. Patients and Methods: In this descriptive-analytical study, the dialysis patients who had been on dialysis for more than four months were selected through medical records (N=75). Serum CRP was checked and those who had positive CRP entered in the analysis (n=20). Ten patients had been used atorvastatin at a dose of 20 mg daily and the other 10 patients received aspirin at a dose of 80 mg daily for two months. Serum CRP concentration was measured in all patients at the end of these two months. Results: The mean age of the patients was 65.6 years and the mean number of years on dialysis was three years. In addition, 65% of patients were male and 35% were female. The only significant relationship was between the effect of atorvastatin and CRP concentration and the effect of aspirin on CRP concentration while no statistically significant relationship was found between the two groups of aspirin and atorvastatin in terms of serum CRP value after the intervention. Conclusion: The results indicated that the effect of aspirin and atorvastatin on CRP concentration was positive in hemodialysis patients and reduced the serum level of CRP, indicating the anti-inflammatory role of these two drugs in hemodialysis patients. It should be noted that drug preference was not determined in the present study. [ABSTRACT FROM AUTHOR]

Background: Previous studies reported that neonatal and maternal complications as well as duration of labor could be diminished through labor management. Therefore, we aimed to evaluate the effect of intramuscular (IM) administration of atropine and hyoscine combination on labor progress and maternal and neonatal outcomes in primigravid women admitted to Taleghani Hospital of Arak, Iran. Methods: In this double-blind, placebo-controlled clinical trial, 216 primigravid women were randomly allocated to four groups (54 cases in each group) as follows: atropine group received 0.01-0.5 mg (1cc) of IM atropine; hyoscine group received 20 mg of IM hyoscine in a single dose; atropine and hyoscine combination group received 0.01-0.5 mg of atropine and 20 mg of IM hyoscine in a single dose; and control group only received IM injection of 1cc distilled water in a single dose. Thereafter, Bishop score, duration of the active phase and the second stage of labor, type of delivery, and Apgar scores at one and five minutes were recorded. Chi-square/Fisher's exact tests and One-way ANOVA were run, using SPSS version 20. Results: The Bishop scores were significantly higher in the atropine and hyoscine groups, compared to the other groups (P<0.05). Duration of the active phase in the atropine and hyoscine combination group was significantly shorter than the other groups (P=0.001). However, there was not a significant difference between the four groups in terms of duration of the second stage and Apgar scores at one and five minutes (P>0.05). Conclusion: The atropine and hyoscine combination reduced the duration of active phase in the primigravid women without serious maternal or neonatal adverse effects. [ABSTRACT FROM AUTHOR]

Background: To have a thorough understanding of epidemic surveillance, it is essential to broaden our knowledge of death tolls worldwide. This study aimed to determine the age-standardized mortality rate (ASMR) and predictors of mortality among coronavirus disease 2019 (COVID-19) patients., Materials and Methods: In this cross-sectional design, all COVID-19 patients with a positive polymerase chain reaction test in the population covered by Arak University of Medical Sciences (AUMS) were entered to the study. Data collection was conducted by phone interview. The study variables comprised age, sex, coronary heart diseases, diabetes, and some symptoms at admission. The adjusted odds ratio (OR) and 95% confidence intervals (CIs) were obtained by logistic regression. The direct method was applied to calculate ASMR (per 100,000) of COVID-19. The analysis was applied by STATA software 12.0., Results: A total of 208 cases of COVID-19 (out of 3050 total infected cases) were dead and 2500 cases were recovered. The mean age of dead patients was 70 years. The COVID-19 fatality rate in the population equaled 6.8%; in those patients who were 70 years old or more, however, the case fatality rate was 16.4%. The ASMR of COVID-19 was 12.9 (CI 95%: 11.2, 14.8). The odds of COVID-19-related death in the age over 60 were 10.87 (CI 95%: 6.30, 18.75) times than lower 45 years old. Moreover, it was observed that COVID-19 significantly increased the odds of COVID-19-related death in diabetes patients (OR = 1.45, CI 95%: 1.02, 2.06, P = 0.036)., Conclusion: The ASMR of COVID-19 was relatively higher in males than females. In general, the COVID-19 fatality rate was relatively high. We found that older age and diabetes can have impact on the death of COVID-19, but the headache was found to have a negative association with the COVID-19-related death., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Education and Health Promotion.)

Background: Cardiovascular disease accounts for 40% of the world's fatality and after accidents and traumas, is the second leading cause of death in Iran. Given the role of psychological characteristics such as hostility and anger in the development of certain behaviors and habits affecting heart problems, this study aimed to investigate the relationship between hostility and anger with coronary artery disease., Methodology: In this cross-sectional study, 320 patients referring to the hospital with coronary artery stenosis enrolled in the study and were available for angiography. Data collection tools included demographic and disease status questionnaires and aggression questionnaire. The data were analyzed by SPSS software version 16, and Spearman's correlation coefficient, Student's t-, and one-way analysis of variance tests was used for the statistical analysis., Results: In this case, we have the following. Out of 302 cases, 183 were males and 119 were females. One hundred and ninety-seven patients with coronary artery disease and 105 patients with angiography had no coronary artery disease., Conclusion: People with coronary artery disease and healthy controls had no significant differences in demographic characteristics, history of illness, and education. Furthermore, there was no statistically significant relationship between hostility and anger with vasoconstriction. Since there is no relationship between hostility and anger with coronary artery disease, further studies are needed to investigate the presence of mediating variables to design appropriate and preventive interventions., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Education and Health Promotion.)