An Innovative Method to Enhance the Modified DOTS for TB Patients

BACKGROUND

Nowadays establishing communication and educating patients to enhance their knowledge regarding disease and treatment process at home is one of the most important principles in providing patient care.

MATERIALS AND METHODS

A semi-experimental study was done on 57 patients with active pulmonary tuberculosis in two care groups namely professional - family mix directly observed treatment short- course (PFM-DOTS) and family based-DOTS (FB-DOTS). The patients were referred to the tuberculosis and lung diseases research center for diagnosis and treatment of pulmonary tuberculosis. Both the patient and a family supervisor were evaluated regarding their level of knowledge of the disease and the treatment regimen.

RESULTS

A significant difference between the degree of knowledge of groups of patients and the groups of family relatives before and after the intervention was indicated, with a higher increase in PFM-DOTS group than in F-B-DOTS group (P< 0.001). In PFM- DOTS group 100% of the patients, and in the FB-DOTS group 86.8% of the patients followed the recommended drug regimen (P<0.001).

CONCLUSION

According to the treatment recommendations by the World Health Organization (WHO) for appropriate implementation of DOTS project combating TB, it seems the PFM-DOTS implementation is a more suitable method with greater effects on correct care and treatment of tuberculosis patients.

[Association of stress hyperglycemia and in-hospital complications]

BACKGROUND

Stress hyperglycemia is the elevation of serum glucose found in a patient, once he is admitted in the hospital. The objective of this study was to evaluate the impact of admission serum glucose level in the outcome of noncritical hospitalized patients.

METHODS

A prospective analytical cohort study was conducted in patients hospitalized in the Internal Medicine service of the Hospital de Especialidades, Centro Médico Nacional Siglo XXI (Instituto Mexicano del Seguro Social), from September 2011 to February 2012.

RESULTS

We included 89 patients with serum glucose level < 110 mg/dL (group A) and 90 patients with serum glucose > 110 mg/dL (group B). Diabetes mellitus was more frequent in group B (p < 0.001). Glycosylated hemoglobin greater than 6.5 % was found in 36.4 % of the patients in group B and in 8.7 % in group A (p < 0.001). Patients in group B had higher APACHE II score (p = 0.02) and worse in-hospital outcomes.

CONCLUSIONS

Stress hyperglycemia was associated with higher APACHE II score and more medical complications, such as sepsis, urinary tract infection, pneumonia and use of pressor amines. Mortality independent predictors were systemic arterial hypertension and APACHE II score.

Management of liver hemangioma using trans-catheter arterial embolization

BACKGROUND

Hemangioma, a congenital vascular malformation, is the most common benign liver lesion that is usually remain stable subsequently requiring not treatment; however, complications such as abdominal pain or fullness, coagulation disturbances, and inflammatory syndrome may occur, demanding a specific treatment of hemangioma.

OBJECTIVES

To assess the safety, feasibility and efficacy of trans-catheter arterial embolization (TAE) for the treatment of Liver hemangioma.

PATIENTS AND METHODS

TAE was performed on 20 patients with liver hemangioma. The embolic agent used was polyvinyl alcohol (PVA) particles (300-400 micron, Jonson and Johnson Cordis, USA). All patients were followed up for 6 months. Imaging was carried out and patients were also evaluated symptomatically through telephone interview by a physician.

RESULTS

Twenty patients aged from 21 to 63 years (mean: 46.8, SD: 10.26) were included in this study. Post embolization syndrome, including abdominal pain, fever, and leukocytosis occurred in one patient 1 week after TAE and lasted for 3 days. No serious adverse event and TAE-related death was observed. None of the patient underwent another intervention including surgery. During follow up interval, decreased episode of abdominal pain was documented in all patients who had pain. Tumor enlargement was also stopped during the follow up. The average diameter of tumors was 97.00 mm (range: 25-200 SD: 47.85) and 88.95 mm (range: 23-195 SD: 43.27) before and after embolization, respectively. Comparison of images before and after TAE revealed statistically significant decrease in the size of lesion (P value: 0.004, t: 3.31).

CONCLUSIONS

Our findings indicate that TAE is a safe and efficient procedure for the treatment of liver hemangioma. Further studies with larger sample sizes are required to support therapeutic effects of TAE.

Translation and psychometric properties of the persian version of the dialysis symptom index in hemodialysis patients

Background:

Hemodialysis patients have a high physical and psychosocial symptom burden. There is no valid and reliable tool for assessing symptoms of hemodialysis patients in Iran.

Objectives:

The aim of this study was to determine psychometric properties of the Persian version of the dialysis symptom index (DSI).

Patients and Methods:

The forward-backward procedure was applied to translate the DSI from English into Persian (Iranian language). The scale (Persian Version) was tested with a convenience sample of 95 patients with end-stage renal disease referred to main hemodialysis centers from December 2012 to June 2013. Validity was assessed using content, face and convergent validity. To test reliability, the kappa values were calculated for test-retest stability and the Cronbach alpha coefficients were also calculated for internal consistency.

Results:

The mean age of patients was 50.4 (SD = 15.72) years and % 61.1 of patients were male. The most commonly reported symptoms were fatigue, being irritable and nervous. Divergent validity was mostly supported by the pattern of association between DSI and SF-36 (r = -0.18– -0.48, P< 0.05). Cronbach’s alpha of the DSI was 0.90 and the weighted kappa ranged from 0.21 to 0.93, and it was greater than 0.4 for 25 of the 30 items.

Conclusions:

The Iranian version of the DSI had good psychometric properties and can be used to assess symptoms of hemodialysis patients.

Association between body mass index and urinary tract infection in adult patients

Background:

Overweight and obesity have become a global public health over the last decades. Obesity has been suggested to be a risk factor for some infections, but studies often showed controversial findings. Few studies examined the relationship between body mass index (BMI) and urinary tract infection (UTI), showing inconsistent results.

Objectives:

The purpose of this study was to determine the relationship between BMI and UTI in adult patients.

Patients and Methods:

Adult patients (≥ 18 years old) who were referred to clinics or admitted in hospital with diagnosis of UTI were considered for participation in the study. Control group were selected from healthy adult normal population whom underwent medical check-ups at the same hospital and without history of UTI. Data about age, gender, history of diabetes mellitus and BMI were registered for individuals who met inclusion criteria.

Results:

A total of 116 patients with UTI and 156 people as the control group were included in the study. Two groups were matched for age, gender and history of diabetes mellitus. Mean BMI ± SD of patients was 25.2 ± 4.0 kg/m² and the controls was 25.1 ± 3.6 kg/m². There was no significant correlation between BMI and UTI (P = 0.757). Mean BMI ± SD of patients with upper UTI was 25.6 ± 4.1 kg/m² and for lower UTI was 24.9 ± 4.0 kg/m². There was no significant difference between BMI of controls and patients with any type of UTI (P = 0.573).

Conclusions:

Our findings did not found an association between BMI and UTI and does not support obesity as a risk factor for UTI in adult patients.

Distribution of hepatitis B virus genotypes in azerbaijani patients with chronic hepatitis B infection

BACKGROUND

Hepatitis B virus (HBV) has been classified into ten genotypes (A-J) based on genome sequence divergence, which is very important for etiological and clinical investigations. HBV genotypes have distinct geographical distributions worldwide.

OBJECTIVES

The aim of this study was to investigate the distribution of HBV genotypes among Azerbaijani patients with chronic hepatitis B, came from the Republic of Azerbaijan country to Iran to receive medical care.

PATIENTS AND METHODS

One hundred and three patients with chronic HBV infection, referred to hospitals related to Iran University of Medical Sciences and Tehran Hepatitis Center from August 2011 to July 2014, were enrolled in this cross sectional study. About 3-milliliter of peripheral blood was taken from each patient. After viral DNA extraction, HBV genotypes were tested using the INNO-LiPA™ HBV kit (Innogenetics, Ghent, Belgium). HBV genotyping was confirmed using sequencing of hepatitis B surface antigen (HBsAg) and polymerase (pol) regions of HBV.

RESULTS

The mean age of patients was 35.9 ± 11.7 years (19-66). Of 103 patients, 72 (69.9%) were male. In the present study, the predominant HBV genotype was D (93.2%) followed by genotype A (5.8%) and concurrent infection with A and D genotypes (0.97%).

CONCLUSIONS

The main and frequent HBV genotype among Azerbaijani patients with chronic hepatitis B virus infection was genotype D followed by genotype A.

Dealing with coronary artery disease in early encountering: a qualitative study

BACKGROUND

The prevalence of cardiovascular diseases is rising in industrial and developing countries. Coronary Artery Disease (CAD) is the most common cardiovascular disease. Thus, understanding the signs and risk factors of CAD from the patients' perspective and their ways of dealing with this disease is of vital importance.

OBJECTIVES

This qualitative study aimed to explore the Iranian patients' viewpoints about CAD and how they dealt with it in their first encounter.

PATIENTS AND METHODS

This study was a qualitative content analysis conducted on 18 patients with CAD. The data were collected through semi-structured interviews. Initially, purposeful sampling was performed followed by maximum variety. Sampling continued until data saturation. Then, all the interviews were recorded and transcribed verbatim. After all, the data were analyzed by constant comparative analysis using MAXQUDA2010 software.

RESULTS

The themes manifested in this study included "invasion of disease" with subthemes of "warning signs" and "risk factors" and "confrontation strategies" with subthemes of "seeking for information", "follow-up", and "control measures".

CONCLUSIONS

The results of this study described the patients' perceptions of CAD and how they dealt with this disorder in early encountering. Based on the results, physicians and nurses should focus on empowerment of patients by facilitating this process as well as by educating them with regards to dealing with CAD.

Robotic and navigation systems in orthopaedic surgery: how much do our patients understand?

BACKGROUND

Technology in orthopaedic surgery has become more widespread in the past 20 years, with emerging evidence of its benefits in arthroplasty. Although patients are aware of benefits of conventional joint replacement, little is known on patients' knowledge of the prevalence, benefits or drawbacks of surgery involving navigation or robotic systems.

METHODS

In an outpatient arthroplasty clinic, 100 consecutive patients were approached and given questionnaires to assess their knowledge of navigation and robotics in orthopaedic surgery. Participation in the survey was voluntary.

RESULTS

Ninety-eight patients volunteered to participate in the survey, mean age 56.2 years (range, 19 to 88 years; 52 female, 46 male). Forty percent of patients thought more than 30% of National Health Service (NHS) orthopaedic operations involved navigation or robotics; 80% believed this was the same level or less than the private sector. One-third believed most of an operation could be performed independently by a robotic/navigation system. Amongst perceived benefits of navigation/robotic surgery was more accurate surgery (47%), quicker surgery (50%), and making the surgeon's job easier (52%). Sixty-nine percent believed navigation/robotics was more expensive and 20% believed it held no benefit against conventional surgery, with only 9% believing it led to longer surgery. Almost 50% would not mind at least some of their operation being performed with use of robotics/navigation.

CONCLUSIONS

Although few patients were familiar with this new technology, there appeared to be a strong consensus it was quicker and more accurate than conventional surgery. Many patients appear to believe navigation and robotics in orthopaedic surgery is largely the preserve of the private sector. This study demonstrates public knowledge of such new technologies is limited and a need to inform patients of the relative merits and drawbacks of such surgery prior to their more widespread implementation.

Obligatory information that a patient diagnosed of prostate cancer and candidate for an active surveillance protocol must know

OBJECTIVES

To know the necessary information to reproduce the results found in the literature on active surveillance (AS) in prostate cancer (PCa) in our own center so that the information would be objective and correctly given to the patients. We have aimed to study the percentage of candidates for AS chosen in our setting, and the data on infrastaging, subgrading and prediction of insignificant PCa, debugging the predictive value of clinical variables to improve our selection criteria and finally to analyze the results of our patients enrolled in AS.

MATERIALS AND METHODS

A retro- and prospective review of our data bases was performed. A one-year period was analyzed to know AS candidates. Analysis of our radical prostatectomy specimens for infrastaging, subgrading and prediction of insignificant PCa (Epstein's criteria) was made as well as a uni/multivariate analysis of clinical variables in patients with insignificant PCa in the specimen. A prospective validation was performed with overall survival and survival free of active treatment (SFAT) as endpoints in patients enrolled in AS.

RESULTS

Between October-2010/October-2011, 44.7% of our PCa were candidates for AS, but only 11.2% choose it. The percentages found for infrastaging, subgrading and prediction of insignificant PCa were 14%, 31.4% and 55.7%, respectively. However, only just 6 patients (6.97%) had≥pT3a+Gleason≥7+volume>0.5cc PCa. The multivariate analysis showed that PSA density and number of affected cores were independent predictors of insignificant PCa. With a mean follow-up of 36±39months, 63 out of 232 patients enrolled in AS went on to active treatment (27.1%), with only 13 due to anxiety without pathologic progression. Median time of SFAT was 72.7 months (CI 95% 30.9-114.4). SFAT at 24 months was 76.4% (69.7-83.1%) and at 48 months 58.1% (48.8-67.4%). Only 10 patients died (4.3%), 9 due to causes different of PCa. Estimated overall survival at 5 years was 92.8% (CI 95% 86.7-98.9%).

CONCLUSIONS

It should be mandatory to have the exact knowledge of the local data of each Center in order to objectively inform patients about prostate biopsy efficiency, and if percentages of infrastaging, subgrading and prediction of insignificant PCa are in accordance with the literature. At 3 years, we reproduced the results of the longest series of AS, so we have ascertained that our AS protocol can be implemented with increasingly more patients.

When do doctors follow patients' orders? Organizational mechanisms of physician influence

Physicians, like other professionals, are expected to draw from specialized knowledge while remaining receptive to clients' requests. Using nationally representative U.S. survey data from the Community Tracking Study, this paper examines the degree to which physicians are influenced by patients' requests, and how physicians' workplaces may mediate acquiescence rates through three mechanisms: constraints, protection, and incentives. We find that, based on physicians' reports of their responses to patients' suggestions, patient influence is rare. This influence is least likely to be felt in large workplaces, such as large private practices, hospitals, and medical schools. We find that the protection and incentives mechanisms mediate the relationship between workplace types and physician acquiescence but more prescriptive measures such as guidelines and formularies do not affect acquiescence. We discuss these findings in light of the ongoing changes in the structure of medicine.

A comparison of genetic findings in sudden cardiac death victims and cardiac patients: the importance of phenotypic classification

Sudden cardiac death (SCD) is responsible for a large proportion of non-traumatic, sudden and unexpected deaths in young individuals. Sudden cardiac death is a known manifestation of several inherited cardiac diseases. In post-mortem examinations, about two-thirds of the SCD cases show structural abnormalities at autopsy. The remaining cases stay unexplained after thorough investigations and are referred to as sudden unexplained deaths. A routine forensic investigation of the SCD victims in combination with genetic testing makes it possible to establish a likely diagnosis in some of the deaths previously characterized as unexplained. Additionally, a genetic diagnose in a SCD victim with a structural disease may not only add to the differential diagnosis, but also be of importance for pre-symptomatic family screening. In the case of SCD, the optimal establishment of the cause of death and management of the family call for standardized post-mortem procedures, genetic screening, and family screening. Studies of genetic testing in patients with primary arrhythmia disorders or cardiomyopathies and of victims of SCD presumed to be due to primary arrhythmia disorders or cardiomyopathies, were systematically identified and reviewed. The frequencies of disease-causing mutation were on average between 16 and 48% in the cardiac patient studies, compared with ∼10% in the post-mortem studies. The frequency of pathogenic mutations in heart genes in cardiac patients is up to four-fold higher than that in SCD victims in a forensic setting. Still, genetic investigation of SCD victims is important for the diagnosis and the possible investigation of relatives at risk.

Effect of supportive nursing care on self esteem of patients receiving electroconvulsive therapy: a randomized controlled clinical trial

INTRODUCTION

Self-esteem is an important potential indicator in etiology, diagnosis and treatment of patients with severe mental illness. ECT is a popular treatment for these patients that can effect on their self-esteem and reinforce their problems. The purpose of this study is to determine the effect of supportive nursing care in increasing self esteem of patients receiving ECT.

METHODS

This clinical trial was conducted in the Baharan psychiatric hospital of Zahedan. A total of 70 cases of patients who received ECT were randomly allocated to control (n=35) and intervention (n=35) groups. The data were collected by demographic characteristics questionnaire and Rosenberg Self Esteem Scale (RSES). Intervention group received the supportive nursing care. The control group received only routine treatment. Self esteem level was measured and compared before and after intervention for two groups. The data was analyzed by SPSS using the χ(2), t-test and ANCOVA.

RESULTS

RESULTS showed that both groups were homogeneous on the socio- demographic characteristics. The mean self esteem in the intervention group compared with the control group was significantly increased. While controlling the effects of individual and social variables, the result shows significant differences between two groups in the mean scores of self esteem after the intervention.

CONCLUSION

The results suggest that supportive nursing care can have positive effect on self esteem of patients receiving ECT. It is recommended to use this method for increasing self esteem of these patients.

Access family functioning and related factors from the viewpoints of male cancer patients

INTRODUCTION

Assessment of family functioning is essential prior to planning any family-based intervention for cancer patients. In an extensive literature review, any relevant studies related to the functions of Iranian families with cancer patient was not found. Therefore, the aims of present study were to investigate the function of Iranian families with a male cancer patient and its related factors from patients' perspectives.

METHODS

This was a descriptive- corelational study in which 101 men with cancer admitted to Tabriz Shahid Ghazi hospital were participated by convenience sampling method. Family assessment device was used for data collection that investigates family functioning in problem solving, communication, roles, affective involvement, affective responsiveness, behavior control, and general functioning domains. Also, demographic characteristics were collected. The higher score indicates better family functioning. Data analyzed by SPSS software version13 using descriptive and inferential statistics is including independent samples t-test, one-way ANOVA and Pearson correlation tests.

RESULTS

Male participants in this study reported inappropriate family functioning in all domains. The lower score was on communication and the higher score was on behavior control domain. There was significant statistical correlation between patients' perception of family functioning with the participants' education level and job, while, there was no significant correlation between patients' score of family functioning with age, life situation, number of children, age of senior child, marriage duration and time passed since diagnosis.

CONCLUSION

Inappropriate family functioning reported by the male cancer patients indicates importance of providing consultation services for cancer patients and their family.

The efficacy of thermotherapy and cryotherapy on pain relief in patients with acute low back pain, a clinical trial study

INTRODUCTION

Acute low back pain is one of the most common health problems especially in industrialized countries where 75 per cent of the population develop it at least once during their life. This study examined the efficacy of thermotherapy and cryotherapy, alongside a routine pharmacologic treatment, on pain relief in patients with acute low back pain referring an orthopedic clinic in Shahrekord, Iran.

MATERIALS AND METHODS

This clinical trial study was conducted on 87 patients randomly assigned to three (thermotherapy and cryotherapy as intervention, and naproxen as control) groups of 29 each. The first (thermotherapy) group underwent treatment with hot water bag and naproxen, the second (cryotherapy) group was treated with ice and naproxen, and the naproxen group was only treated with naproxen, all for one week. All patients were examined on 0, 3(rd), 8(th), and 15(th) day after the first visit and the data gathered by McGill Pain Questionnaire. The data were analyzed by SPSS software using paired t-test, ANOVA, and chi-square.

RESULTS

In this study, mean age of the patients was 34.48 (20-50) years and 51.72 per cent were female. Thermotherapy patients reported significantly less pain compared to cryotherapy and control (p≤0.05). In thermotherapy and cryotherapy groups, mean pain in the first visit was 12.70±3.7 and 12.06±2.6, and on the 15(th) day after intervention 0.75±0.37 and 2.20±2.12, respectively.

CONCLUSION

The results indicated that the application of thermo-therapy and cryotherapy accompanied with a pharmacologic treatment could relieve pain in the patients with acute low back pain.

Correlation between the Time to Surgery and That to Recovery from Postoperative Diplopia Based on a Single-Center, Retrospective Experience: A Case Series of 11 Patients

Background

We conducted this study to identify the correlation between the time to surgery and that to recovery from postoperative diplopia.

Methods

In the current single-center, retrospective study, we enrolled a total of 11 patients (n=11) who were diagnosed with white-eyed blowout fracture and underwent surgical operation at our institution between January 2009 and January 2013. To identify the correlation between the time to surgery and that to recovery from postoperative diplopia, we divided our patients into the three groups: the group A (time to surgery, <2 days) (n=4), the group B (time to surgery, 3-7 days) (n=4) and the group C (n=3) (time to surgery, 8-60 days). Then, we compared such variables as sex, age, signs of soft tissue injury, preoperative nausea/vomiting, the degree of preoperative diplopia and the side of the fracture on computed tomography scans between the three groups.

Results

In our series, mean age at the onset of trauma was nine years (range, 5-16 years); the mean time to surgery was 30 days (range, 2-60 days); and the mean follow-up period was one year (range, 6 months-2 years). Our results showed that the time to recovery was shorter in the patients with a shorter time to surgery.

Conclusions

We found that the degree of recovery from impaired ocular motility and diplopia was the highest in the patients undergoing surgical operations within 48 hours of the onset of trauma with the reconstruction of the fracture sites using implant materials.

Prevalence and Correlates of Missed First Appointments among Outpatients at a Psychiatric Hospital in Nigeria

BACKGROUND

Missed appointments are common in psychiatric practice. It compromises quality of care, results in poor treatment outcomes and drains financial resources. In Nigeria, where mental health services are poorly organized, missed appointments and its resultant consequences may be burdensome.

AIM

This study sought to determine the prevalence and factors (sociodemographic and clinical) associated with missed clinic appointments at a regional psychiatric hospital.

SUBJECTS AND METHODS

A study on a cohort of patients attending the Outpatient Clinics for the first time between June and September 2011 was conducted. We interviewed each participant at their first presentation then tracked through case records to determine adherence to scheduled first clinic appointments after 4 weeks. A questionnaire was used in eliciting sociodemographic characteristics, clinical variables, and patient/caregiver satisfaction with treatment. Descriptive statistics were used to summarize the data and inferential statistics to test associations using the SPSS 16.

RESULTS

Three hundred and ten patients were recruited over the study period. The prevalence of missed first appointment was 32.6% (101/310). Participants who were single (P = 0.04), living alone (P < 0.01) or aggressive (P < 0.01) were more likely to miss their first appointment. However, having received previous treatment for a psychiatric illness (P = 0.02) and having comorbidity (P = 0.05) was associated with less likelihood to miss a first appointment. A binary logistic regression analysis showed that having received previous treatment independently predicted a less likelihood to miss first appointment (P = 0.03).

CONCLUSION

Quite a proportion (32.6%) of patients attending outpatient clinics miss scheduled clinic appointments. Receiving previous psychiatric care predicted adherence to scheduled appointment.

To study the levels of C - reactive protein and total leucocyte count in patients operated of open and laparoscopic cholecystectomy

BACKGROUND

The recovery from laparoscopic cholecystectomy (LC) is rapid and most of the patients are discharged on the 1st post-operative day. There is an increased concentration of certain serum proteins, known as acute-phase reactive proteins (APRP) during the post-operative period depends on the degree of tissue damage and the inflammatory reaction. There is a direct positive correlation between the concentrations of APRP, especially C-reactive protein (CRP), and the severity of inflammation. This study was done to study the levels of C - reactive protein and Total Leucocyte Count in patients operated either by Open Cholecystectomy (OC) and Laparoscopic Cholecystectomy (LC).

MATERIALS AND METHODS

This prospective study was conducted on 50 patients after approval from the Institutional Ethics Committee. Twenty five patients underwent open cholecystectomy and the other 25 had laparoscopic cholecystectomy. The pre and post operative concentrations of serum C-reactive protein (CRP) and total leukocyte count (TLC) were compared in both the groups.

RESULTS

There were no differences in the preoperative serum CRP and TLC concentrations - in both the groups. Serum CRP rose significantly following OC compared to that of patients who underwent LC (10.52 ± 1.96 mg% vs. 8.88 ± 1.23 mg %). There were also significant differences in the post-operative TLC ( 9.49 ± 1.05 m/mm3 for the OC group vs. 8.57 ± 1.31 m/mm3 for the LC group), and the post-operative hospital stay (5.5 ±1.5 days vs. 1.9 ± 0.9 days). There was no correlation between serum CRP concentrations and the other post-operative parameters.

CONCLUSION

The study provided the biochemical evidence supporting the clinical observation that LC is far less traumatic to the patient than OC.

Serum soluble CD40 Ligand levels are associated with severity and mortality of brain trauma injury patients

BACKGROUND

Serum soluble CD40 Ligand (sCD40L) levels, which exhibit prothrombotic and proinflammatory properties, have not been studied in patients with traumatic brain injury (TBI). Thus, the objective of this study was to determine whether serum sCD40L levels are associated with severity and mortality in patients with severe TBI.

METHODS

This was a prospective, observational and multicenter study carried out in six Spanish Intensive Care Units. Patients with severe TBI defined as Glasgow Coma Scale (GCS) lower than 9 were included, while those with Injury Severity Score (ISS) in non-cranial aspects higher than 9 were excluded. Serum levels of sCD40L were measured on the day of TBI. Endpoint was established in 30-day mortality.

RESULTS

We found higher serum sCD40L levels (P<0.001) in non-surviving TBI patients (N=27) than in survivor ones (N=73). Logistic regression analysis showed that serum sCD40L levels were associated with 30-day mortality (OR=1.58; 95% CI=1.12-2.21; P=0.008) controlling for APACHE-II score and computer tomography findings. The area under the curve (AUC) for serum sCD40L levels as predictor of 30-day mortality was 0.79 (95% CI=0.70-0.86; P<0.001). Survival analysis showed that patients with serum sCD40L levels higher than 2.11 ng/mL presented increased 30-day mortality than patients with lower levels (Hazard ratio=9.0; 95% CI=4.25-19.27; P<0.001). We found an association between serum sCD40L levels and APACHE-II (rho=0.33; P=0.001), and GCS score (rho=-0.21; P=0.04).

CONCLUSIONS

To our knowledge, this is the first study reporting data on serum sCD40L levels in patients with severe TBI. The most relevant and newer findings of our study are that serum sCD40L levels in non-surviving patients with severe TBI are higher than in surviving ones, and that there are an association between serum sCD40L levels and TBI severity and mortality.

High levels of Zinc-α-2-Glycoprotein among Omani AIDS patients on combined antiretroviral therapy

OBJECTIVE

To investigate the levels of zinc-α-2-glycoprotein (ZAG) among Omani AIDS patients receiving combined antiretroviral therapy (cART).

METHODS

A total of 80 Omani AIDS patients (45 males and 35 females), average age of 36 years, who were receiving cART at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman, were tested for the levels of ZAG. In addition, 80 healthy blood donors (46 males and 34 females), average age of 26 years, attending the SQUH Blood Bank, were tested in parallel as a control group. Measurement of the ZAG levels was performed using a competitive enzyme-linked immunosorbent assay and in accordance with the manufacturer's instructions.

RESULTS

The ZAG levels were found to be significantly higher among AIDS patients compared to the healthy individuals (P=0.033). A total of 56 (70%) of the AIDS patients were found to have higher levels of ZAG and 16 (20%) AIDS patients were found to have high ZAG levels, which are significantly (P>0.031) associated with weight loss.

CONCLUSIONS

ZAG levels are high among Omani AIDS patients on cART and this necessitates the measurement of ZAG on routine basis, as it is associated with weight loss.

[Fibromyalgia patients' perceptions of the impact of the disease in the workplace]

Objetivo

Explorar las percepciones de pacientes con fibromialgia (FM) sobre los problemas que experimentan en el ámbito laboral, para analizar cómo se enfrentan a ellos y se adaptan a las limitaciones derivadas de los síntomas de esta enfermedad.

Diseño

Estudio cualitativo exploratorio realizado en 2009.

Emplazamiento

Asociaciones de pacientes con FM de la Comunidad Valenciana (España).

Participantes

Dieciséis personas (13 mujeres y 3 hombres) diagnosticadas de FM por un reumatólogo, de distintas edades y ocupaciones, seleccionadas a partir de informantes clave y por la técnica de bola de nieve.

Método

Muestreo pragmático. Entrevistas semiestructuradas hasta alcanzar la saturación de la información cuando no emergían contenidos nuevos. Análisis de contenido cualitativo utilizando el software informático Atlas.ti-5 para generar y asignar códigos, formar categorías e identificar un tema latente.

Resultados

Se identificaron 4 categorías: las dificultades para cumplir las exigencias laborales, la necesidad de apoyo social en el entorno laboral, las estrategias adoptadas para continuar trabajando y la resistencia a abandonar el mercado de trabajo. De forma transversal a estas categorías emergió un tema: la disposición de permanecer o reincorporarse al mercado laboral.

Conclusiones

Se requiere atender las necesidades específicas de los pacientes con el fin de que logren permanecer en el mercado laboral, de acuerdo a sus capacidades. Para ello, emerge la necesidad de programas de sensibilización sobre las consecuencias de la FM en el entorno laboral para lograr la colaboración de los directivos, empresarios, profesionales de Atención Primaria y médicos del trabajo.

[Measuring the satisfaction of patients admitted to the intensive care unit and of their families]

OBJECTIVE

To determine the level of satisfaction of family members with the care and decision making process, and to know the level of satisfaction of patients discharged from ICU.

DESIGN

A prospective, observational and descriptive study with a duration of 5 months was carried out.

SETTING

The ICU of Marqués de Valdecilla University Hospital, Santander (Spain).

SUBJECTS

Family members of adult patients admitted to the ICU and patients discharged to the ward.

INTERVENTION

INSTRUMENT

Family Satisfaction Intensive Care Survey (FS-ICU 34) of family members of patients discharged to the ward. We adapted the FS-ICU 34 in relation to care for application to the patients.

RESULTS

A total of 385 questionnaires were obtained: 192 from families of survivors and 162 from patients, and 31 from relatives of non-survivors. The majority of relatives were satisfied with overall care and overall decision making (survivors: 83.46 ± 11.83 and 79.42 ± 13.58, respectively; non-survivors: 80.41 ± 17.27 and 79.61 ± 16.93, respectively). Patients were very satisfied with the care received (84.71 ± 12.85).

CONCLUSIONS

The level of satisfaction of the relatives of patients admitted to the ICU is high, in the same way as the degree of patient satisfaction. Still, there are several points that should be improved, such as the waiting room environment and the atmosphere of the ICU in terms of noise, privacy and lighting. In relation to the decision making process, there are also some aspects that may be improved, such as the provision of hope regarding recovery of the critically ill relative.

Patients' perceptions of how healthcare providers communicate with them and their families following a diagnosis of colorectal cancer and undergoing chemotherapy treatment

PURPOSE

Chemotherapy can result in many unpredictable and often debilitating side-effects hence patients undergoing chemotherapy treatment may have to rely on their loved ones to support them through this most challenging period. In view of this possibility then good communication skills between patients, healthcare providers and family members is of paramount importance for effective patient outcomes. The aim of this study therefore, was to explore patients' perceptions of how healthcare providers communicate with them and their family members whilst undergoing chemotherapy treatment for cancer.

METHODS

Using a qualitative methodology and a descriptive design, data were collected using unstructured interviews with patients undergoing chemotherapy (n = 14) and analysed by content analysis.

RESULTS

Participants expressed that both they and their family members were treated with compassion, kindness, empathy and understanding. They appreciated the time given to them and their family members to listen and answer their questions before, during and/or after treatment. In addition they commented positively on the warm and cheerful environment and the selective use of appropriate humour by oncology healthcare providers in the chemotherapy units.

CONCLUSION

The data highlights in particular the positive communication encounters between patients with cancer and their healthcare providers and family members. Oncology nurses were identified as being particularly supportive to both patients and their family members. Despite chemotherapy units being a difficult place to be a part of, this study highlights that healthcare providers can help make this a less daunting place for patients and their family members through their appropriate use of professional communication.

Assessing the nursing and midwifery students competencies in communication with patients with severe communication problems

BACKGROUND

Clients with communication impairment are at risk for health disparity. Hence, health care workers should be knowledgeable and skillful in communication. However, no studies are available on Iranian nursing and midwifery students' communication skills with patients with severe communication problems.

OBJECTIVES

The present study was conducted to investigate Iranian nursing and midwifery students' competencies in communication with patients with severe communication problems.

MATERIALS AND METHODS

This study was performed on all senior nursing and midwifery students of Kashan University of Medical Sciences in spring 2013. Data were collected through a knowledge questionnaire and two checklists for evaluation of skills needed for communication with patients with severe communication problems. Data analysis was performed through independent samples t test, and Fisher's exact test.

RESULTS

In total, 68.8% of the participants were female, 37.6% had a history of part-time job as a nurse or midwife. The mean score of knowledge were 4.41 ± 1.42 and 4.77 ± 1.77 for nursing and midwifery students, respectively and the difference was not significant (P = 0.312). In addition, the mean score of communication skills with deaf patients was 13.23 ± 4.68 and 11.86 ± 5.55 for nursing and midwifery students, respectively and the difference was not significant (P = 0.258). Also, the mean score of communication skills with stutter patients was 23.91 ± 4.17 and 21.25 ± 3.91 for nursing and midwifery students, respectively but the difference was not significant (P = 0.269).

CONCLUSIONS

Nursing and midwifery students did not significantly differ in terms of communication with patients with severe communication problems. Most of the students had low or very low knowledge and skills in communication with patients with hearing impairment. However, they had better skills in communication with patient with speech problem. Special workshops or training programs are recommended to empower nursing and midwifery students in communication with patients with communication problems.

Sexual Behavior and Sexual Satisfaction according to Gender in Korean Patients with Cancer

PURPOSE

This study was done to investigate sexual behavior and sexual satisfaction according to gender difference in Korean patients with cancer.

METHODS

In this study, a convenience sample of Korean patients with cancer who visited hospitals in J City was used. Data were collected between September and December 2012using structured questionnaires: Sexual frequency scale and General sexual satisfaction index (GSSI).

RESULTS

Over half of the patients reported loss of sexual desire and changes in sexual behaviors. There was a significant decrease in sexual satisfaction among the male patients, compared to the female patients (t=2.34, p=.020). There were significant correlations between sexual satisfaction and sexual behaviors (male patients r=.45, p<.001; female patients r=.59, p<.001).

CONCLUSION

The results of this study demonstrate the need to take gender into account in developing interventions for patients with cancer. These results will also contribute to the development of improved interventions for sexual health care.

Transdermal fentanyl patches versus patient-controlled intravenous morphine analgesia for postoperative pain management

Background:

Acute and severe pain is common in patients postoperatively and should be correctly managed. In the past years studies on preparing better postoperative pain control have resulted in development of postoperative pain management guidelines. Perhaps, one of the major improvements in managing postoperative pain is the development of the patient-controlled analgesia systems (PCA), especially through intra venous (IV), extradural and transdermal routes, which has resulted in marked improvements in acute postoperative pain management. Physicians administrate potent opioids for moderate to severe post-surgical pains. Morphine is the most commonly IV-PCA administrated analgesic. The fentanyl iontophoretic transdermal system (fentanyl ITS) is also another efficient option for pain management.

Objectives:

The aim of this study was to compare the analgesic effects of these two routine postoperative pain control systems.

Patients and Methods:

We enrolled 281 patients (224 males, 57 females) in this blind randomized controlled clinical trial, who had undergone an orthopedic surgery, with the mean age of 33.91 ± 14.45 years. Patients were randomly divided into two groups; in group A patients received IV-morphine PCA pump and in group B fentanyl transdermal patches were attached on patients’ arms. The severity of the pain was registered according to Visual Analogue Scale in specially designed forms by pain-trained nurses in two steps; first after the surgery and next before the beginning of analgesic effects. After 24 hours, the pain score was assessed again.

Results:

No significant difference was observed in mean pain intensity score at the first patient assessment. Mean pain intensity scores were also similar in both groups at the last measured time point (P > 0.05). Differential pain intensity scores, showing the impacts of analgesic system on the pain experience of the patients was also similar between fentanyl patches (6.48 ± 2.20) and morphine PCIA (6.40 ± 1.80). (P > 0.05) Mean patient satisfactory score (scale: 0–100) was also similar in both groups (P > 0.05). The percentage of patients, whose differential pain intensity scores at 24 hours reached our pain management goal was similar between fentanyl and morphine groups (P > 0.05). The percentage of patients with at least one adverse event was significantly higher in fentanyl group (P < 0.05). The most frequent adverse events were nausea, vomiting and itching. In none of the groups, no patient experienced serious adverse events related to the studied medications.

Conclusions:

Although both pain killing therapeutic regimens are safe and effective for postoperative pain management, regarding the easy usage of the patches, lower risk of abuse and cost-effectiveness in the Iranian market, it is recommended for use in Iranian hospitals and trauma centers and in countries with similar socioeconomic situations.

The communication experiences of patients with palliative care needs: A systematic review and meta-synthesis of qualitative findings

OBJECTIVE

Optimal communication is essential in ensuring that the palliative care needs of patients are met. This continues to be an area of concern for healthcare providers. The goal of our present review was to gain a deeper understanding of the communication experiences of patients with palliative care needs that have been identified within the qualitative literature.

METHOD

A systematic search for qualitative research papers was undertaken in February of 2012. Five databases (ASSIA, CINAHL, MEDLINE, PsychArticles, and PsychINFO) were searched using the search terms ["palliative care" OR "terminal care" OR "end of life care"] AND ["experience" OR "perspective" OR "qualitative" OR "interview"] AND ["patients" OR "clients" OR "service-user"]. Meta-synthesis was conducted on the data within the found papers.

RESULTS

A line-of-argument synthesis of 15 studies yielded four overarching themes: talking-facilitating and inhibiting factors; the importance of humanitarian qualities within communication encounters; perceptions of autonomy within communication experiences; and individual differences in preferences for honesty within interactions.

SIGNIFICANCE OF RESULTS

Our findings are discussed in relation to existing literature and offer a deeper insight into the communication experiences of this clinical population. A number of clinical implications are offered for the healthcare professionals who are providing support to patients with palliative care needs.

Expert and experiential knowledge in the same place: patients' experiences with online communities connecting patients and health professionals

OBJECTIVE

To explore patients' experiences with online health communities in which both physicians and patients participate (i.e. patient-to-doctor or 'P2D' communities).

METHODS

A qualitative content analysis was conducted, based on observations in five P2D communities ranging from 8 to 21 months, and semi-structured interviews (N=17) with patients.

RESULTS

Patients consider information from physicians and peers as two distinct sources, value both sources differently and appreciate accessing both in the same web space. According to respondents, physicians can provide 'reliable' and evidence-based information, while patients add experience-based information. Patients use this information for multiple purposes, including being informed about scientific research and personal reflection.

CONCLUSION

Patients find P2D communities beneficial because they help patients to collect information from both medical experts and experiential experts in one place.

PRACTICE IMPLICATIONS

Patients use P2D communities to perform medical, emotional and lifestyle activities. The presence of physicians in P2D communities may inadvertently suggest that the quality of information used for the activities, is controlled. When information is not officially being checked, this should be stated explicitly on the website and supplemented with a statement that information is only indicative and that patients should at all times contact their own physicians.

Factors associated with severe uncontrolled asthma and the perception of control by physicians and patients

INTRODUCTION

Despite current treatments, more than half of patients with asthma are not controlled. The objective was to evaluate the correlation between control perceived by patients and physicians, compared with control evaluated according to criteria of the Spanish Guidelines for Asthma Management (GEMA), and to investigate the factors associated with that control.

METHODS

Multicenter, cross-sectional, observational study including 343 patients with severe persistent asthma according to GEMA criteria seen in the Department of Pulmonology and Allergology. The correlation between asthma control perceived by the patient, the physician and according to clinical judgment based on the GEMA criteria was calculated, and a multivariate analysis was used to determine variables related to the perception of asthma control.

RESULTS

According to GEMA criteria, only 10.2% of patients were well controlled, 27.7% had partial control and 62.1% were poorly controlled. Both the physicians and the patients overestimated control: 75.8% and 59.3% of patients had controlled asthma according to the patient and the physician, respectively, and were not controlled according to GEMA (P<.0001). Patients with uncontrolled asthma according GEMA had higher body mass index (P=.006) and physical inactivity (P=.016). Factors associated with a perceived lack of control by both physicians and patients were: nocturnal awakenings (≥ 1 day/week), frequent use of rescue medication (≥ 5 days/week) and significant limitation in activities. Discrepant factors between physicians and patients were dyspnea and emergency room visits (patients only), FEV1 ≤ 80% and a poorer understanding of the disease by the patient (physicians only).

CONCLUSIONS

Only 10% of patients with severe asthma evaluated in this study are controlled according to GEMA criteria. Patients and physicians overestimate control and the overestimation by patients is greater. Physical inactivity and obesity are associated with a lack of control according to GEMA.

Vaccination of healthcare workers to protect patients at increased risk of acute respiratory disease: summary of a systematic review

Healthcare workers (HCWs) are at increased risk of exposure to respiratory pathogens and may transmit infection to vulnerable patients. This study summarises a recent systematic review, which aimed to assess evidence that influenza or pneumococcal vaccination of HCWs provides indirect protection for those patients most at risk of severe or complicated acute respiratory infection. A number of healthcare databases and sources of grey literature were searched using a predefined strategy, and citations screened for eligibility in accordance with specified inclusion criteria. Risk of bias was assessed using validated tools and results summarised qualitatively. Twenty papers were included in the final review, all of which considered influenza vaccination of HCW. As such, planned subanalysis of pneumococcal vaccination was discarded. The majority of primary research studies included (11/14) were conducted in long-term care facilities, but there was marked heterogeneity in terms of the population, intervention/exposure and outcomes considered. Consistency in the direction of effect was observed across several different outcome measures, suggesting that influenza vaccination of HCWs is likely to offer some protection. Further evidence is, however, required from acute care settings.

Determining the factors contributing to quality of life of patients at the last stage of life: a qualitative study

BACKGROUND

Quality- of- life of patients at their last stage of their life are different from that of other people.

OBJECTIVES

The aim of this study was to determine the factors contributing to the quality- of- life of patients at their last stage of their life and provide good cares for these patients.

PATIENTS AND METHODS

This qualitative study was performed by the thematic- framework method of analysis. Twenty three participants including patients, their families, nurses, physicians, psychologists and clergymen were selected sampling. Data were collected by semi - structured interview. We used the thematic framework method to analyze qualitative data.

RESULTS

Seven factors which needed to be considered in the patients' at last stage quality of life included stress reduction, participation, homecare, education, independency, support, recourses and facilities. According to the findings, the number of these factors may be more than what was mentioned above.

CONCLUSIONS

Paying attention to the quality of life at the last stage can be helpful for patients and their families and the special care can be taken for them.

Comparison of empathy score among medical students in both basic and clinical levels

INTRODUCTION

Empathy refers to a personality character that has a great role in communication with others. Thus, proper evaluation and education of empathy in medical students is important for medical education. Because previous studies had suggested that physician's empathy may reduce with clinical trainings, in this study we decided to measure the empathy score among medical students.

METHODS

This is a cross-sectional study conducted on medical students in the first to seventh years of their studies at Shiraz medical school (south of Iran) in 2010. We designed new Iranian version questionnaire of the Jefferson Scale of Physician Empathy. Sample size was 260 students and the results were analyzed in SPSS, version 11.5 (statistical tests such as descriptive methods, t-test, and ANOVA) and p<005 was considered as the significant level.

RESULTS

The empathy score decreased with increase in the students' age (p=0.001) and educational level (p=0.030). The overall rate of empathy score in basic science level (65.5±0.84) was more than that in the clinical level (55.5±1.78). The lowest empathy score was seen in the seventh year students (55.51) and the highest was in the first year students (65.50). Female students had higher mean empathy score (65.53) while it was 59.02 in the male students.

CONCLUSION

In general, medical students in Shiraz University of Medical Sciences had low empathy level and this may be a cause for concern; as such we suggest a possible inclusion of courses on empathy in the curriculum.

Knowledge and attitude of healthcare workers and patients on healthcare associated infections in a regional hospital in Ghana

Objective

To assess knowledge and attitude of healthcare workers (HCWs) and patients on healthcare associated infections (HAIs) in the central regional hospital in Ghana.

Methods

The purposive random sampling method was used to administer questionnaires over a period of 6 months to HCWs and patients visiting the hospital.

Results

A total of 210 patients and 71 HCWs were sampled. One hundred and three (53.8%) patients had some knowledge of HAIs with 52 (28.4%) being informed by a HCW compared with 63 (88.7%) of HCWs who were well informed about HAIs. Ninety-seven (46.2%) responding patient always washed their hands while 65 (31%) and 48 (22.9%) respectively sometimes or never washed their hands within or after leaving the hospital. Out of those who washed their hands, 64 (39.5%) always washed with soap while 46 (28.4%) did sometimes. This positively and significantly correlated (r=0.440, P<0.001) with knowledge on HAIs which was however insignificant in HCWs (r=0.025, P=0.835). As many as 48 (67.6%) of HCWs believed that authorities in the hospital had done little to prevent HAIs with the main reason being that the hospital was unclean. Whereas, 112 (53.3%) of patients considered the hospital clean. Twenty-seven (38%) of HCWs had had confirmed HAIs of which cholera made up 12 (16.9%) while 94 (44.8%) of patients believed they had had unconfirmed HAIs.

Conclusions

Although knowledge on HAIs is adequate, low compliance on preventive techniques resulting in high HAIs indicates attitudinal change is the best means of prevention.

Consumer characteristics and perceptions of chiropractic and chiropractic services in Australia: results from a cross-sectional survey

OBJECTIVE

The purpose of this study was to describe patient characteristics and summarize their perceptions of chiropractic in Australia.

METHODS

This study is part of a broader study aiming to extend the knowledge of the role of chiropractic within the current health care environment. A 33-item, paper-based, cross-sectional survey of a sample of patients from 100 systematically sampled chiropractic clinics from all the states and territories of Australia was conducted. The survey focused on patient demographics, socioeconomic status, perceived health status, and perceptions of chiropractic and chiropractic services.

RESULTS

A total of 486 responses were received (24.3% response rate). Respondents were predominantly female patients (67.1%) of the 45- to 64-year age group. Approximately half of the respondents reported a pretax annual income exceeding $40000. Most patients sought chiropractic services because of musculoskeletal disorders (68.7%) and for general health (21.2%), and personal beliefs motivated most respondents (70.2%) to visit a chiropractor. Most respondents would seek the chiropractic services again (97.5%) and were satisfied with the service received.

CONCLUSIONS

The results of this study show that the typical chiropractic patient in Australia is a middle-aged woman with a moderate to high income. Although only a small proportion of the Australian population sees a chiropractor, this group seems to be satisfied with the service.

Dyspnea-12-Arabic: testing of an instrument to measure breathlessness in Arabic patients with chronic obstructive pulmonary disease

OBJECTIVE

The aim of this study was to develop the Dyspnoea-12-Arabic (D-12-A) questionnaire and test its reliability and validity for the assessment of breathlessness in Arabic speaking patients with chronic obstructive pulmonary disease (COPD) in Jordan.

BACKGROUND

Breathlessness is a complex multidimensional symptom which incorporates physiology and psychology.

METHODS

The D-12-A, Hospital Anxiety and Depression Scale (HADS), and Quality of Life Index pulmonary version (QLI-P) were completed by 67 Jordanian patients with COPD. Cronbach alpha was used to assess internal consistency, and Pearson product-moment correlation calculated for construct validity.

RESULTS

The D-12-A and its sub-components ('physical' and 'affective') demonstrated excellent internal reliability (Cronbach alpha range from 0.88 to 0.91). D-12-A scores correlated significantly with other relevant outcome measures and demonstrated good construct validity.

CONCLUSIONS

The D-12-A should provide clinicians and researchers with a useful tool for the assessment of breathlessness in Arabic speaking patients with COPD.

Customers' complaints and its determinants: the case of a training educational hospital in iran

BACKGROUND

Today, despite the efforts of the medical community and healthcare staff along with the advancements in medical technology, patients' dissatisfaction and complaints have been increased. The present study aimed at making a survey on the patients' complaints in a large training hospital affiliated to Mashhad University of Medical Sciences (MUMS).

METHODS

This descriptive, cross-sectional study was conducted on written and verbal complaints of patients and their relatives in a tertiary (specialty and sub-specialty) training hospital. All the recorded patients' complaints, from March to December 2012, were reviewed. Data were categorized and analyzed using descriptive statistics by Microsoft Excel 2007.

RESULTS

A total of 233 complaints were reviewed, of which 46.35%, 31.34% and 22.31%, respectively, were verbal, written and made on the phone. The main reasons for complaints were accessibility to medical staff (21.46%), communication failures (20.17%) and dissatisfaction with the provided care (14.59%). Thirty one (13.31%) cases were solved at first place, 194 (83.26%) referred to the complaints from the committee and 3.43% referred to the legal authorities. The average response time was about six to seven days.

CONCLUSION

The findings of the study suggest that sufficient availability of medical staff, improvement in communication skills and paying attention to the patients' needs and expectations may reduce complaints from public health facilities.

Serum cystatin C as a marker of renal function in critically ill patients with normal serum creatinine

Background:

Serum creatinine as a classic marker of renal function has several limitations in the detection of renal dysfunction.

Objectives:

This study assessed the validity of serum cystatin C as a marker of renal function in critically ill patients with normal serum creatinine.

Patients and Methods:

Eighty adult patients referred to intensive care units with serum creatinine levels < 1.5 mg/dL and without hemodynamic instability were chosen and their serum creatinine and cystatin C levels were measured. A 24-hour urine sample was collected to calculate creatinine clearance (Ccr). Renal dysfunction was defined as Ccr < 80 mL/min/1.73 m².

Results:

There were significant correlations between measured Ccr and 1/serum creatinine (R = 0.51, P < 0.001) and 1/serum cystatin C (R = 0.25, P = 0.028). The difference between false negative rates of serum creatinine (93.33%) and cystatin C (80%) in the detection of renal dysfunction was significant (P = 0.032). Receiver operating characteristic curve analysis illustrated that area under the curve of serum creatinine and cystatin C for detecting renal dysfunction were 0.711 and 0.607, respectively; however, this difference was not significant (P = 0.222).

Conclusions:

Our data demonstrated that serum cystatin C is not superior to serum creatinine in the early detection of renal dysfunction in critically ill patients.

Revalidation: A world first in medical regulation

The revalidation of doctors was introduced in the UK in December 2012, and means that all licensed doctors must demonstrate periodically that they are up-to-date and fit to practise. Regular appraisals, based on the General Medical Council’s core guidance for doctors, will be used by responsible officers to evaluate a doctor’s practice based on six types of supporting information, including feedback from patients and colleagues. In this commentary, as the Chair of the General Medical Council and Consultant Physician, I provide an overview of the history of revalidation and discuss the role of the new system of checks (which is being watched with interest by regulators around the world) ensuring that medical practice is of a high quality, that doctors are supported in their professional development and, most importantly, that patients can have confidence in the doctors they consult.

Serum 25-hydroxyvitamin D levels and survival in colorectal and breast cancer patients: systematic review and meta-analysis of prospective cohort studies

AIM

To estimate the association between serum 25-hydroxyvitamin D (25(OH)D) levels and survival among colorectal and breast cancer patients.

METHODS

We performed a comprehensive literature search of prospective cohort studies assessing the association of serum 25(OH)D levels with survival in colorectal and breast cancer patients. Study characteristics and results were extracted and dose-response relationships were graphically displayed in a standardised manner. Meta-analyses using random effects models were performed to estimate pooled hazard ratios.

RESULTS

The systematic search yielded five studies including 2330 colorectal cancer patients and five studies including 4413 breast cancer patients all of which compared mortality across two to five categories of 25(OH)D levels. Among colorectal cancer patients, pooled hazard ratios (95% confidence intervals) comparing highest with lowest categories were 0.71 (0.55-0.91) and 0.65 (0.49-0.86) for overall and disease-specific mortality, respectively. For breast cancer patients, the corresponding pooled estimates were 0.62 (0.49-0.78) and 0.58 (0.38-0.84), respectively. No significant evidence of heterogeneity between studies was observed.

CONCLUSION

Higher 25(OH)D levels (>75nmol/L) were associated with significantly reduced mortality in patients with colorectal and breast cancer. Randomised controlled trials are needed to evaluate whether vitamin D supplementation can improve survival in colorectal and breast cancer patients with low vitamin D status (25(OH)D<50nmol/L) at diagnosis and before treatment.

Empathy from the nurses' viewpoint in teaching hospitals of tabriz university of medical sciences, iran

INTRODUCTION

Empathy is the ability to put one in the place of others and to better understand their feelings and experiences. According to researchers, there is a type of challenge in using this concept in nursing field. In most cases, the term empathy substitutes other concepts. Regarding this point, it seems quite necessary to research and discuss different dimensions of this concept in different studies. This study aimed to determine empathy regarding the nurses' point of view.

METHODS

In this descriptive study sample size was selected according to study population or in the other hand all the nurses in 3 general hospital was selected because they are the most important teaching hospital in Tabriz. LEP (La Monica Empathy Profile) was used as empathy tool. Data were analyzed by SPSS Ver. 13.0.

RESULTS

In nonverbal behavior dimension, touching the patient was considered as the most effective methods. On the other hand, nurses could not always be able to control stress and they could not always being with patients to show their empathy. Many people believe that nurses showed very little feelings while raggedly the reflective enclosure and they occasionally had to change their schedules to talk to patients.

CONCLUSION

In most cases the nurses support nonverbal behavior, such as reflective, close and touching encountering in establishing relationship with the patient. However, to improve this situation, planning for nurses to become familiar with the ways through which they can express their interest to show empathy would be effective.

Effects of a new nutraceutical substance on clinical and molecular parameters in patients with chronic venous ulceration

Pathophysiological events involved in the onset of chronic venous ulceration (CVU) are inflammation, activation of polymorphonucleates (PMNs) and secretion of proteases such as matrix metalloproteinases (MMPs), which degrade extracellular matrix (ECM) that is a support for vascular and tissutal wall. MMPs, neutrophil gelatinase-associated lipocalin (NGAL) and inflammatory cytokines are overexpressed in CVUs and they could play a central role in pathophysiological mechanisms of skin lesion and delayed wound healing. Bioflavonoids, such as diosmin and other compounds, appear to have several provessel function activities including anti-inflammatory, antioxidant and phlebotonic effects and are widely used in the treatment of chronic venous disease (CVD)-related problems. In this article, we evaluated the effects of Axaven(®) , a new nutraceutical on both clinical and molecular parameters in patients with CVUs. During the study period, 83 patients with CVUs of both sexes were enrolled and divided into two groups: group A (treated group): 25 females and 19 males (median age is 67·7 years) received standard treatment (compression therapy and surgical correction of superficial venous incompetence) + Axaven(®) once a day for 8 months as adjunctive treatment. Group B (control group): 24 females and 15 males (median age is 65·2 years) were treated only with basic treatment according to their clinical conditions. In our study, the administration of Axaven(®) in patients with CVUs was able to decrease inflammatory cytokines, MMPs and NGAL, inducing an improvement of both symptoms with an increase of the speed of wound healing.

Determining the impact of community awareness-raising activities on the prevention of malaria transmission in Palawan, the Philippines

Palawan has the highest malaria endemicity in the Philippines, and malaria remains a major health burden in the region. In 1999, 344 microscopists were trained in Palawan. This allowed for early diagnosis and prompt treatment throughout the island. To take a significant step toward the elimination of malaria on the island, microscopists implemented community awareness-raising activities aimed at preventing transmission of malaria. The objective of the present study was to determine the impact of these activities on the self-implemented preventive measures against malaria by the ex-patients of the microscopists. Structured interviews were carried out from January to February in 2012, in 20 remote malaria-endemic villages throughout Palawan. In total, 141 ex-patients who had previously been diagnosed malaria-positive by the microscopists, volunteered to participate in the present study. Structural equation modeling was conducted to determine factors associated with self-implemented preventive measures against malaria, which included: (1) place of residence; (2) socio-demographic characteristics; (3) knowledge on malaria; (4) participation in community awareness-raising activities for malaria prevention; and (5) satisfaction with microscopists. Structural equation modeling identified six significant factors independently associated with self-implemented preventive measures against malaria; ethnicity, knowledge on malaria transmission, knowledge on vector species, knowledge on vector's most active time, participation in awareness-raising activities for malaria prevention by microscopists, and satisfaction with microscopists. Tagalog ethnicity (the predominant ethnic group) was positively related to better self-implemented preventive measures. In conclusion, aside from providing early diagnosis and treatment, microscopists played a significant role in self-implemented preventive measures against malaria. The strengthening of awareness-raising activities by microscopists was suggested to be an effective strategy for reducing malaria re-infection in Palawan. These activities should be strengthened to improve preventive measures implemented by ex-patients traveling to mountain areas and to enhance the knowledge on malaria transmission particularly among indigenous residents.

A Randomized Clinical Trial Study: Anti-Oxidant, Anti-hyperglycemic and Anti-Hyperlipidemic Effects of Olibanum Gum in Type 2 Diabetic Patients

Diabetes is a common metabolic disease in the world that has many adverse effects. Olibanum gum resin (from trees of the genus Boswellia) has traditionally been used in the treatment of various diseases such as diabetes. The aim of this study was the comparison of Olibanum gum resin effect with placebo on the treatment of type 2 diabetes. Inclusion criteria was diabetic patients with fasting blood sugar (FBS) =140-200 mg/dL. This study has been designed as double-blined clinical trial on 71 patients with type 2 diabetes and the patients randomly were divided to interventional and placebo groups. The patients on standard anti-diabetic therapy (metformin) treated with Olibanum gum resin (400 mg caps) and placebo tow times per day for 12 weeks, respectively. At the end of the twelfth week, the FBS, HbA1c, Insulin, total Cholesterol (Chol), LDL, Triglyceride (TG), HDL and other parameters were measured. The Olibanum gum resin lowered the FBS, HbA1c, Insulin, Chol, LDL and TG levels significantly (p < 0.001, p < 0.001, p <0.001, p = 0.003, p < 0.001 and p < 0.001, respectively) without any significant effects on the other blood lipid levels and liver/kidney function tests (p > 0.05) compared with the placebo at the endpoint. Moreover, this plant showed anti-oxidant effect and also no adverse effects were reported. The results suggest that Olibanum gum resin could be used as a safe anti-oxidant, anti-hyperglycemic and anti-hyperlipidemic agent for type 2 diabetic patients.

Caries management by risk assessment care paths for prosthodontic patients: oral microbial control and management

The development of an oral care path focuses on the identification of the early indicators of disease. Once the risks have been identified and diagnosed, the proper therapies can be selected and prescribed. The experienced practitioner must meld clinical experience and observation with evidence-based scientific dentistry and information on the treatment and prevention of continued disease for the prosthodontic patient after restorations have been completed. The incorporation of dental implants has not allowed for complications of caries and periodontal disease on teeth and implants. Osseoseparation is necessary for justification of continued maintenance.

A review of the social, psychological, and economic burdens experienced by people with spina bifida and their caregivers

INTRODUCTION

Despite measures to reduce the incidence of neural tube defects (NTDs), the rate of decline has not been as dramatic as expected. At least 300,000 newborns worldwide are known to be affected by NTDs each year. This comprehensive literature review summarizes the human and economic burden of NTDs to patients and caregivers, with particular focus on spina bifida (SB).

METHODS

PubMed, PsycINFO, and Embase were searched for studies from January 1976 to November 2010 that included clinical terms, such as NTD, and at least one patient-reported outcome or cost term. A conceptual model was also developed.

RESULTS

Areas of peoples' lives affected by SB included physical and role functioning, activities of daily living, bodily pain, vitality, emotional functioning, mental health, self-esteem, self-image, social functioning, relationships, and sexual functioning. Areas of caregivers' lives affected included activities of daily living, work impact, time consumption, parental responsibilities (including responsibilities to other children), confidence, feelings and emotions, mental health, stress, social impact, psychological adjustment, relationships (with SB child, siblings, other family members), social support, coping strategies, and termination decisions. Cost burdens on patients and caregivers also include out-of-pocket costs, lost wages, or household production due to increased morbidity and mortality, transportation and other nonmedical costs.

CONCLUSIONS

This review highlights the need to provide care and support to individuals with SB and their caregivers. Results also emphasize the importance of effective long-term public health campaigns and/or newer strategies to prevent NTDs, such as SB.

Self-management support needs of patients with chronic illness: do needs for support differ according to the course of illness?

OBJECTIVE

To determine whether chronically ill patients' needs for self-management support depend on their course of illness.

METHODS

Cross-sectional and longitudinal linear regression analyses were conducted using data from 1300 patients with chronic disease(s) who participated in a nationwide Dutch panel-study. Self-management support needs were assessed by the Patient Assessment of Self-management Tasks questionnaire (PAST). Course of illness was operationalized as: illness duration, patients' perception of the course of illness and changes in self-rated general health (RAND-36).

RESULTS

Self-management support needs are not related to illness duration. Patients who perceive their illness as episodic and/or progressively deteriorating have greater self-management support needs than patients who perceive their illness as stable. Deterioration of self-rated health is related to increased support needs. The effect of the course of illness on support needs depends on the type of self-management activities.

CONCLUSION

How chronically ill patients perceive the course of illness and actual changes in self-rated health are predictive for their need for support for self-management activities. Illness duration is not.

PRACTICE IMPLICATIONS

Helping patients to self-manage should not be confined to the first years after diagnosis. Healthcare providers should be alert to patients' own perceptions of their course of illness and health status.

What are important for patient centered care? A quantitative study based on perception of patients' with cancer

INTRODUCTION

Today in all aspects of health care, there is a considerable emphasis on the provision of patient centered care. Various researches in cancer wards have demonstrated that from view of patients, there were some similarities and differences in importance of care in different cultural area. This study aimed to assess what are important for patient centered care in cancer wards.

METHODS

This is a descriptive study conducted with  participation of 200 patients with cancer  from a cancer center in Tabriz. Convenience sampling was used. The data were collected using Care-Questionnaire, developed by Larson. The Caring behaviors were ordered in 6 dimensions: "Being accessible", "Explains and facilitates", "Comforts", "Anticipates", "Trusting relationship", "Monitors and follows through" and ordered on a 5-point Likert-type scale. The data were analyzed using SPSS ver. 13.0. 

RESULTS

The results showed that patients with cancer evaluated most of nurses caring behaviors with higher scores (moderate to high) and  assigned the "Monitors and follows through" and "Being accessible" as patients' higher priorities vs the "Comforts" 4.06 (0.50) and "Trusting Relationships" as lower priorities.

CONCLUSION

The findings of the present study, indicate that the "Monitors and follows through" and "Being accessible" caring behaviors have more importance by patients with cancer, so these conduces nurses to notice and perform these behaviors in their nursing care. By so doing, moving to the main goal of patient centered care can be provided.

Prevalence and risk factors of postoperative delirium in patients undergoing open heart surgery in northwest of iran

INTRODUCTION

Delirium as a relatively common complication following cardiac surgery remains a contributory factor in postoperative mortality and an obstacle to early discharge of patients.

METHODS

In the present study 329 patients who underwent open heart surgery between 1st January 2008 to 1st January 2009 in Shahid Madani Heart Center, Tabriz, Iran were enrolled.

RESULTS

Overall 4.9% of patients developed delirium after cardiac surgery. We found atrial fibrillation (P = 0.005), lung diseases (P = 0.04) and hypertension (P = 0.02) to be more common in patients who develop delirium postoperatively. Furthermore, the length of intensive care unit (ICU) stay, cardiopulmonary bypass (CPB) time, and ventilation period were also significantly increased. Also a statistically meaningful relationship between the female gender and development of delirium was also noted (P = 0.02). On the other hand no meaningful relationship was detected between diabetes, history of cerebral vascular diseases, peripheral vascular diseases, myocardial infarction, development of pneumonia following surgery, and laboratory levels of sodium, potassium, glucose, and complete blood cell count (CBC) including white blood cells, red blood cells, platelets in the blood-hemoglobin and hematocrits. Also environmental factors like presence of other patients or companion with the patient, and objects like clock, window and calendar in the patient's room did not affect prevention of delirium.

CONCLUSION

Based on this and other investigations, it can be suggested to use MMPI test to recognize pathologic elements to prevented delirium after surgery and complementary treatment for coping with delirium.

Improving pharmacy practice through public health programs: experience from Global HIV/AIDS initiative Nigeria project

Background

The use of medicines is an essential component of many public health programs (PHPs). Medicines are important not only for their capacity to treat and prevent diseases. The public confidence in healthcare system is inevitably linked to their confidence in the availability of safe and effective medicines and the measures for ensuring their rational use. However, pharmacy services component receives little or no attention in most public health programs in developing countries. This article describes the strategies, lessons learnt, and some accomplishments of Howard University Pharmacists and Continuing Education (HU-PACE) Centre towards improving hospital pharmacy practice through PHP in Nigeria.

Method

In a cross-sectional survey, 60 hospital pharmacies were randomly selected from 184 GHAIN-supported health facilities. The assessment was conducted at baseline and repeated after at least 12 months post-intervention using a study-specific instrument. Interventions included engagement of stakeholders; provision of standards for infrastructural upgrade; development of curricula and modules for training of pharmacy personnel; provision of job aids and tools amongst others. A follow-up hands-on skill enhancement based on identified gaps was conducted. Chi-square was used for inferential statistics. All reported p-values were 2-tailed at 95% confidence interval.

Results

The mean duration of service provision at post-intervention assessment was 24.39 (95% CI, 21.70–27.08) months. About 16.7% of pharmacies reported been trained in HIV care at pre-intervention compared to 83.3% at post-intervention. The proportion of pharmacies with audio-visual privacy for patient counseling increased significantly from 30.9% at pre-intervention to 81.4% at post-intervention. Filled prescriptions were cross-checked by pharmacist (61.9%) and pharmacy technician (23.8%) before dispensing at pre-intervention compared to pharmacist (93.1%) and pharmacy technician (6.9%) at post intervention. 40.0% of pharmacies reported tracking consumption of drugs at pre-intervention compared to 98.3% at post-intervention; while 81.7% of pharmacies reported performing periodic stock reconciliation at pre-intervention compared to 100.0% at post-intervention. 36.5% of pharmacies were observed providing individual counseling on medication use to patients at pre-intervention compared to 73.2% at post-intervention; and 11.7% of pharmacies had evidence of monitoring and reporting of suspected adverse drug reaction at pre-intervention compared to 73.3% at post-intervention. The institution of access to patients’ clinical information by pharmacists in all pharmacies at post-intervention was a paradigm shift.

Conclusion

Through public health program, HU-PACE created an enabling environment and improved capacity of pharmacy personnel for quality HIV/AIDS and TB services. This has contributed in diverse ways to better monitoring of patients on pharmacotherapy by pharmacists through access of pharmacists to patients’ clinical information.