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Poor treatment concordance is one of the major problems in patients with hypertension (HTN). An appropriate teaching method can help solving this problem. This study aimed to determine the effect of blended education program on treatment concordance in patients with HTN. This is a single-blind randomized controlled trial, and 60 patients with HTN who met inclusion criteria were selected by a convenience sampling and allocated into the control and intervention groups. A demographic information form and the questionnaires were used in this study. The questionnaires included questions addressing treatment concordance, which explored three dimensions: dietary adherence, medication adherence, physical activity plan. The blended educational intervention was carried out for 4 weeks in the intervention group. The control group only received traditional face-to-face education. The results showed that there was a significant increase in the total score of treatment concordance of the intervention group compared to the control group after the intervention (P < .001). In conclusion, using a blended education program is highly recommended to improve treatment concordance in patients with HTN. Consequently, it reduces patients' medical costs and enhances their health-related quality of life.

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BACKGROUND: Long intervals of del Nido (DN) solution administration, 90 minutes, may result in rewarming of the myocardial tissue and elevate metabolic demand and hypoxia. This will potentially increase inflammatory response due to ischemia-reperfusion injury. We conducted this study to compare the inflammatory response between patients receiving DN and multi-dose St Thomas' cardioplegia solution (MST) in cardiopulmonary bypass (CPB) surgery for the correction of tetralogy of Fallot (TF). METHODS: Fifty-nine pediatric patients undergoing TF total correction surgery were randomly assigned into two groups: DN and MST. The patients' demographic data, blood chemistry parameters, hemodynamics and other clinical variables were recorded. TNF-a, IL-6, IL-8, IL-10 and cTnI were measured after anesthesia induction (before skin incision), immediately after cross-clamp removal and 24 hours after admission to the intensive care unit (ICU). RESULTS: Thirty-two patients of a mean age of 28.0±16.4 months received DN and 27 patients of a mean age of 24.2±15.9 months received MST. Perioperative clinical parameters were not significantly different between the two groups. Cytokine levels for all patients were significantly increased after surgery. Inter-group comparisons of cytokine levels demonstrated no significant differences in TNF-α, IL-6 and IL-8 cytokines levels. IL-10 level showed a moderately significant increase in the MST group compared to the DN group after surgery (2.94±0.9 vs. 2.46±0.61 log10 pg/mL, respectively; p=0.039). Postoperative lactate level was significantly different between two groups (2.475±1.29 vs 1.63±0.82 mg/dL in DN and MST groups, respectively; p=0.007). CTnI levels increased after surgery and remained constant until 24 hours after surgery. Significant differences between the MST and DN groups, at all times, were not detected. CONCLUSIONS: The anti-inflammatory cytokine response in the MST group is significantly better than in the DN group. This may be due to shorter intervals of the MST cardioplegia solution administration, which prevents rewarming of the myocardium, increased metabolic demand and hypoxia. Decreasing the intervals of DN administration may improve its cardioprotective properties.

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INTRODUCTION: Obtaining clinical competency in clinical education is one of the problems in nursing and use of the new methods of clinical training is very important. Clinical supervision is one of the methods used as a mechanism to promote knowledge and skill for promoting professional performance in nursing students. This study is carried out to determine the impact of clinical supervision on field training of nursing students at Urmia University of Medical Sciences. METHODS: In the present experimental study, 32 nursing students were enrolled in the study based on census and randomly assigned into two groups of experimental and control by block randomization. Clinical supervision was used in the experimental group and the control group received routine clinical trainings in the field. The students' clinical skills were assessed using a researcher-made checklist, the validity of which was confirmed through content validity method by 13 faculty members and its reliability was approved by test-retest method on 20 nursing students in the form of a pilot study and through Cronbach's alpha (87%). Data were analyzed using SPSS, version 14. RESULTS: |There was a significant difference between the experimental and control groups in clinical skills such as recognition and administration of medication, team participation,  patients and their relatives' education, considering the safety,  infection prevention and  nursing process (p<0.005). CONCLUSION: The study demonstrated that in clinical supervision process, students have a better communication and cooperation with their instructor and with each other and their confidence and understanding and the amount of learning in practical skills was enhanced more than routine clinical training. The implementation of this clinical training method for students of nursing and other fields of medical sciences is recommendable.