CFSSynergy: Combining Feature-Based and Similarity-Based Methods for Drug Synergy Prediction

Drug synergy prediction plays a vital role in cancer treatment. Because experimental approaches are labor-intensive and expensive, computational-based approaches get more attention. There are two types of computational methods for drug synergy prediction: feature-based and similarity-based. In feature-based methods, the main focus is to extract more discriminative features from drug pairs and cell lines to pass to the task predictor. In similarity-based methods, the similarities among all drugs and cell lines are utilized as features and fed into the task predictor. In this work, a novel approach, called CFSSynergy, that combines these two viewpoints is proposed. First, a discriminative representation is extracted for paired drugs and cell lines as input. We have utilized transformer-based architecture for drugs. For cell lines, we have created a similarity matrix between proteins using the Node2Vec algorithm. Then, the new cell line representation is computed by multiplying the protein-protein similarity matrix and the initial cell line representation. Next, we compute the similarity between unique drugs and unique cells using the learned representation for paired drugs and cell lines. Then, we compute a new representation for paired drugs and cell lines based on the similarity-based features and the learned features. Finally, these features are fed to XGBoost as a task predictor. Two well-known data sets were used to evaluate the performance of our proposed method: DrugCombDB and OncologyScreen. The CFSSynergy approach consistently outperformed existing methods in comparative evaluations. This substantiates the efficacy of our approach in capturing complex synergistic interactions between drugs and cell lines, setting it apart from conventional similarity-based or feature-based methods.

Demanded interdisciplinary subjects for integration in medical education program from the point of view of graduated medical physicians and senior medical students: a nationwide mixed qualitative-quantitative study from Iran

INTRODUCTION

This study aimed to detect interdisciplinary subjects for integration into the medical education program of Iran.

METHODS

A qualitative-quantitative method was used. Firstly, interdisciplinary subjects demanded by medical graduates and senior medical students were defined by qualitative study. In the second stage, questionnaire was developed which based on the findings of qualitative stage, experts' opinion and reviewing of the national general guide of professional ethics for medical practitioners. Questionnaire consisted of demographic, occupational and thirteen interdisciplinary items. These items consisted of social determinants of health, social and economic consequences of disease, social prescribing, physicians' social responsibility, role of gender, racial, ethnic, social and economic issues in approach to patients, role of logic and mathematics in clinical decision-making, philosophy of medicine, maintaining work-life balance, self-anger management, national laws of medicine, religious law in medical practice, health system structure, and teamwork principles. Level and importance of knowledge and self-assessed educational needs were asked about each item. In the third stage, a national online survey was conducted. SPSS 25 was used for statistics.

RESULTS

By content analysis of data in qualitative stage, 36 sub-themes and 7 themes were extracted. In the quantitative part, 3580 subjects from 41 medical universities across Iran participated in this study. 2896 (80.9%) were medical graduates and 684 (19.1%) were senior medical students. Overall, knowledge about interdisciplinary items was low to intermediate, while high to very high knowledge ranged from maximally 38.7% about socioeconomic consequences of disease to minimally 17.2% about social prescribing. Participants gave the most importance to the having knowledge about self-anger management (88.3%), maintaining work-life balance (87.2%) and social determinants of health (85.8%), respectively. However, national laws of medicine (77.6%), maintaining work-life balance (75.4%) and self-anger management (74%) were the first top three educational demands by participants.

CONCLUSION

This study revealed a low to moderate level of knowledge about interdisciplinary topics among both graduated medical physicians and senior medical students. These groups showed a strong demand and tendency to know and to be educated about these topics. These findings underscore the urgency for educational reforms to meet the interdisciplinary needs of medical professionals in Iran.

A comparison between effects of sudoku and mandala painting on anxiety of breast cancer patients undergoing chemotherapy

Introduction

Once diagnosed with breast cancer, many women may experience psychological complications, such as anxiety. The grueling treatments that such patients may undergo, for example, chemotherapy, not only cause specific complications for them but also increase their anxiety level. A technique to manage these psychological consequences in patients with breast cancer is to play Sudoku or do Mandala painting.

Purpose

This study aimed to compare the effects of Sudoku and Mandala painting on the anxiety level of patients with breast cancer undergoing chemotherapy.

Methodology

This randomized clinical trial was conducted on 70 patients with breast cancer in Arak, Iran. The patients who met the inclusion criteria were selected through purposive sampling, and then they were assigned to one of the Mandala painting or Sudoku groups using block randomization. The data were collected using a demographics form and the Spielberger State-Trait Anxiety Inventory (STAI). All participants in both groups completed the research questionnaires before the intervention. The obtained data were analyzed using descriptive and inferential statistics in SPSS-26.

Results

The results indicated that there was a significant difference between the pre-test and post-test anxiety scores in both Sudoku and Mandala painting groups (P = 0.0001). The difference between the pre-test and post-test mean anxiety scores was 6.09 ± 4.02 in the Sudoku group and 48.93 ± 13.8 in the Mandala painting group. The results of the inter-group comparison also showed a significant difference between the two groups in post-test mean anxiety score (P = 0.0001), proving that Mandala painting was more effective in reducing the anxiety of patients.

Conclusion

Mandala painting was more effective than Sudoku in reducing the anxiety level of patients with breast cancer. It can be hence concluded that Mandala painting can be used as a relaxing art therapy technique in these patients.

DeepTraSynergy: drug combinations using multimodal deep learning with transformers

MOTIVATION

Screening bioactive compounds in cancer cell lines receive more attention. Multidisciplinary drugs or drug combinations have a more effective role in treatments and selectively inhibit the growth of cancer cells.

RESULTS

Hence, we propose a new deep learning-based approach for drug combination synergy prediction called DeepTraSynergy. Our proposed approach utilizes multimodal input including drug-target interaction, protein-protein interaction, and cell-target interaction to predict drug combination synergy. To learn the feature representation of drugs, we have utilized transformers. It is worth noting that our approach is a multitask approach that predicts three outputs including the drug-target interaction, its toxic effect, and drug combination synergy. In our approach, drug combination synergy is the main task and the two other ones are the auxiliary tasks that help the approach to learn a better model. In the proposed approach three loss functions are defined: synergy loss, toxic loss, and drug-protein interaction loss. The last two loss functions are designed as auxiliary losses to help learn a better solution. DeepTraSynergy outperforms the classic and state-of-the-art models in predicting synergistic drug combinations on the two latest drug combination datasets. The DeepTraSynergy algorithm achieves accuracy values of 0.7715 and 0.8052 (an improvement over other approaches) on the DrugCombDB and Oncology-Screen datasets, respectively. Also, we evaluate the contribution of each component of DeepTraSynergy to show its effectiveness in the proposed method. The introduction of the relation between proteins (PPI networks) and drug-protein interaction significantly improves the prediction of synergistic drug combinations.

AVAILABILITY AND IMPLEMENTATION

The source code and data are available at https://github.com/fatemeh-rafiei/DeepTraSynergy.

Spiritual Care in Hospitalized Patients in Iran: An Action Research Study

Religious practices can raise the sense of merit and hope through overcoming the feeling of isolation. Studies conducted in this area have indicated that patients may desire to have their spiritual needs met. Nonetheless, sufficient attention has not been paid to these special needs. Therefore, this study aimed to identify the barriers to the provision of spiritual care for hospitalized patients. This is an action research study in which a total of 11 nurses and 76 hospitalized patients were recruited using purposive and convenience sampling, respectively. Data were collected using a combination of qualitative and quantitative methods. In the action cycles, the participants' concerns were examined, constructed, then evaluated, and re-constructed using reflective assessment. The qualitative and quantitative data were analyzed using the content analysis approach and the Mann-Whitney U, Chi-squared, and t-tests, respectively. At the first stage, the results of the content analysis showed the lack of professional knowledge and the existence of organizational barriers in the provision of spiritual care for patients. Reflection in the final stage led to the discovery of four concepts including (a) perceived advantages of change in performance, (b) being capable of providing spiritual care, (c) getting positive feedback, and (d) preparation for improving the provision of spiritual care. The results of the quantitative analysis indicated a significant increase in the mean score of patient satisfaction after the provision of spiritual care (p = .001). The results of this study led the authors to a deeper understanding of various dimensions of spiritual care among patients hospitalized in the cardiology ward and ultimately improved the patients and their families' level of satisfaction.

Complementary and alternative medicine application in cancer patients in Iran

Purpose

Nowadays, complementary and alternative medicine (CAM) is used by cancer patients all over the world. The aim of this study was to investigate the prevalence of CAM use in patients with cancer in Iran.

Methods

This descriptive-analytical study was conducted on 320 cancer patients in Arak. For gathering information, a researcher-made questionnaire was used. This questionnaire was consisted of two parts: demographic and clinical information; and patient’s attitude toward using complementary and alternative medicine treatments and their effectiveness, as well as how much they used different kinds of these treatments. The data were analyzed using SPSS software version 16.

Results

Our findings showed that average age of participants was 55.11 ± 15.58. Most of them had leukemia (25.9%) and underwent chemotherapy (55%), and 141 (44.3%) of individuals were using CAM. Majority of patients (73.2%) were using CAM to improve physical conditions, 61.4% were using it simultaneously with conventional medical treatments, and 25% to reduce pain. Participants have reported visiting holy places, yoga, prayer therapy, and using medicinal plants and special diets, respectively.

Conclusion

Considering the high number of patients using CAM treatments, proper planning and implementation to educate professional members of health team, especially doctors and nurses about CAM treatments is essential. The most important CAM treatments to be educated are spiritual therapies, yoga, medicinal plants, and diet therapy. Moreover, support and education about using these kinds of treatment should be considered in the supportive care program for patients with cancer.

Exposure keratopathy and its associated risk factors in patients undergoing general anesthesia in nonocular surgeries

INTRODUCTION

The most common eye injury during and after general anesthesia is corneal abrasion which can occur at any time after anesthesia and even up to 24 h after it. The aim of this study was to investigate the incidence and factors associated with corneal injury in patients undergoing nonocular surgery.

METHODS

This was a descriptive cross-sectional study. A total of 170 patients, who were admitted to the operating room and met the inclusion criteria, were selected through simple nonprobability sampling. Data collection forms were used in order to assess the incidence of corneal injury and its related risk factors. The National Eye Institute scale with fluorescein paper and cobalt blue light by slit lamp were utilized to examine exposure keratopathy.

RESULTS

Overall, the results showed that the incidence of keratopathy immediately after eye care removal was found to be 64.7% in the operating room, 65.9% in the recovery room, and 41.2% in 24 h after the surgery. Smokers' patients and drug abusers under general anesthesia underwent endotracheal intubation, received more opioids preoperatively, and had more perioperative bleeding and fluid intake. Moreover, in patients who had received more oxygen flow in the recovery room; the rate of keratopathy was higher.

CONCLUSION

Smoking, drug usage, and receiving endotracheal intubation are the risk factors of keratopathy. Therefore, for high-risk patients and procedures, it is indispensable to both obtain preoperative information and take intraoperative precautions in order to prevent eye injuries. Future studies are needed to demonstrate these finding.

The Effects of Passive Blinking on Exposure Keratopathy among Patients in Intensive Care Units

Background

Patients in Intensive Care Units (ICUs) are at risk of eye disorders such as Exposure keratopathy (EK) due to impaired blinking and incomplete eye closure. The aim of this study was to assess the effects of passive blinking exercise (PBE) on EK among patients in ICUs.

Materials and Methods

This single-blind, randomized, clinical trial was conducted in 2017. The study participants included 51 patients purposively recruited from the three ICUs of Valiasr Teaching Hospital, Arak, Iran. Through coin tossing, one eye of each participant was randomly allocated to the intervention group and the other to the control group. The eye in the control group received routine eye care, whereas the eye in the intervention group received routine eye care and PBE for a week. EK prevalence and severity were assessed daily for 7 consecutive days using fluorescein eye staining papers and an ophthalmoscope with a cobalt blue filter.

Results

The study groups did not significantly differ from each other in terms of the baseline prevalence and severity of EK. After the intervention, the prevalence of EK (χ ² = 13.44, df = 1, p < 0.001) and the prevalence of grade II EK (χ ² = 8.33, df = 1, p = 0.003) in the intervention group were significantly lower than the control group.

Conclusions

PBE is effective in significantly reducing EK prevalence and severity among patients in ICUs. Therefore, critical care nurses are recommended to use PBE for EK prevention and management.

Association Between Virtual Social Networks and Health-Promoting Lifestyles in Medical University Students

Background: Medical students make extensive use of virtual social networks, especially in the era of the coronavirus pandemic, so that their health-promoting behaviors may be adversely affected. Objective: This study aimed to determine the relationship between the use of virtual social networks and a health-promoting lifestyle among postgraduate medical students. Materials & Methods: This cross-sectional study was conducted among post-graduate students studying at Tehran University of Medical Sciences in 2020. A total of 240 students were included using quota sampling method. Data were collected via valid and reliable questionnaires consisting of socio-demographic information, health-promoting lifestyle Profile-II, and virtual social networks utilization. The spearman test was employed to evaluate the association between virtual social networks and lifestyle. Results: The mean age of participants was 32.21±7.45 and 75.4% were female. The mean score of lifestyle was 138.28±21.18, while the mean score of virtual social networks utilization was (64.55±11.40). There was a statistically significant correlation between utilization of virtual social networks and total score of lifestyle (r=-0.189, P=0.003), as well as physical activity (r=-0.232, P=0.001), nutrition (r=-0.179, P=0.005), and self-actualization (r=-0.154 , P=0.017) of health promoting lifestyle. Linear regression model showed that utilization of internet and social networks (B=-0.37, P=0.02), utilization in the time between 12 pm and 8 am (B=-14.3, P=0.011) were independently associated with Health Promoting Lifestyle score. Conclusion: This study showed that more than half of students had a healthy lifestyle (55%). The average score of virtual social networks used by students was high. Utilization of internet and the time of utilization were independent predictors of Health Promoting Lifestyle score.

The effect of mandala colouring on anxiety in hospitalized COVID-19 patients: A randomized controlled clinical trial

COVID-19 significantly affects patients' mental health, triggering a wide range of psychological disorders, including anxiety. The aim of this study was to investigate the effect of mandala colouring on the anxiety of hospitalized COVID-19 patients. In this randomized controlled clinical trial, 70 hospitalized patients with COVID-19 were randomly divided between the intervention and control groups. Standard care was provided for both groups. The intervention group spent 30 min/day for six consecutive days performing mandala colouring. Patient anxiety was measured prior and subsequent to the intervention in both groups using the Spielberger State-Trait Anxiety Inventory. Data were analysed using SPSS software version 25. The mean anxiety score was not significantly different between the two groups before the intervention (P = 0.08). Subsequent to the intervention, the mean anxiety score in the intervention and control groups was 44.05 ± 4.67 and 67.85 ± 6.25, respectively, indicating a statistically significant (P = 0.0001) decrease in the anxiety measured among the intervention group as compared with that of the control group. The results of this study show that 30 min of mandala colouring daily is an effective strategy for reducing anxiety in hospitalized COVID-19 patients. Mandala colouring can complement routine treatment and provides a non-pharmaceutical option for decreasing patient anxiety.

Evaluating COVID-19 Related Health Anxiety Among Individuals Referring to Urban Health Centers in Arak, Iran: A Cross-sectional Study

Background and aims: The prevalence of coronavirus disease 2019 (COVID-19) resulted in health anxiety among general population and unreasonable referring to health centers. This study aimed to assess health anxiety related to COVID-19 in individuals referring to healthcare centers of Arak, Iran in 2020. Methods: Using convenient sampling method, the participants of this cross-sectional study were selected from 16 urban health centers of Arak. Salkovskis 18-item Health Anxiety Inventory (HAI-18) was completed by 392 participants. The collected data entered in SPSS software version 24 and was analyzed by Mann-Whitney U and Kruskal-Wallis tests. Results: Mean ± SD of total score of health anxiety was 28.96 ± 7.62. Most participants (74.7%) had medium anxiety and 19.1% had high anxiety. The mean of total score of health anxiety was higher in the 30-59 age range, higher education, single people and students. Participants with chronic diseases and symptoms of cold and people who referred to health centers due to COVID-19 screening had a higher anxiety level. Conclusion: Most people referring to health centers of arak had moderate anxiety. COVID-19-related health anxiety was higher in middle age range, higher education, students, people with chronic diseases, and people with symptoms of common cold.

Improving the endothelial dysfunction in type 2 diabetes with chromium and vitamin D3 byreducing homocysteine and oxidative stress: A randomized placebo-controlled trial

BACKGROUND

Chromium picolinate (CrPic) and vitamin D3 are known as two antioxidant micronutrients. Through inducing endothelial dysfunction, oxidants such as homocysteine (Hct) and malondialdehyde (MDA) lead to cardiovascular disease in type 2 diabetes mellitus (T2DM). No published data has directly examined the effects of these two antioxidants on improving the endothelial dysfunction in T2DM throughreducing homocysteine and oxidative stress.

METHODS

Subjects (n = 92) in this randomized, double blind, placebo-control study were randomly assigned to receive oral placebo (group I), D₃ (group II: 50,000 IU/ week), chromium picolinate (CrPic) (group III: 500 μg/day), and both vitamin D₃ and CrPic (group IV) for four months. Fasting blood samples were drawn at study baseline and following intervention to determine Hct, MDA, total antioxidant capacity (TAC), total thiol groups (SHs), vascular cell adhesion molecule- 1 (VCAM-1), and plasminogen activator inhibitor-1 (PAI-1).

RESULTS

After intervention, MDA significantly decreased in groups II and IV; TAC significantly increased in group IV, and SHs significantly augmented in group III; Hct was significantly reduced in groups II, III, and IV; and VCAM-1 significantly decreased in groups III and IV and PAI-1 was significantly reduced in groups II, III, and IV.

CONCLUSION

Our findings suggest that through reducing homocysteine and oxidative stress and improving endothelial dysfunction, chromium and vitamin D₃ co-supplementation might be predictive and preventive of cardiovascular diseasesassociated with T2DM. IRCT, IRCT20190610043852N1, registered 21 October 2019, https://fa.irct.ir/user/trial/42293/view.

Randomized controlled trial of the foot reflexology on pain and anxiety severity during dressing change in burn patients

BACKGROUND

One of the most important problems in burn patients was pain, especially in dressing changes. This pain can lead to anxiety in the patient. The aim of this study was to determine the effect of foot reflexology on pain and anxiety severity in burn patients.

METHODS

This study was a randomized controlled trial, in which 66 patients with burn injuries referred to Vali-e-asr Hospital, Arak, Iran participated. After obtaining written consent, patients were enrolled to study according to inclusion criteria and then, divided into intervention (n = 33) and control (n = 33) groups using simple random allocation. In the intervention group, in addition to standard care, reflexology was performed for one week on Saturday, Monday and Wednesday (three times in a week). The intervention was done one hour before dressing change in a separate room for 30 min. The control group received only standard care during this time (both intervention and control groups were the same in the type of treatment, and reflexology was considered as an extra care in the intervention group). Severity of pain and anxiety in both groups was measured using visual analog scale twice a day (5-10 min before dressing change and 5-10 min after dressing change) for six days. SPSS software ver. 15 was used for statistical analysis. Mean and standard deviation were used for quantitative variables and qualitative variables were reported as frequency and percentage. Data were analyzed using Chi‑square, Mann-Whitney, Fisher's exact tests, and paired t-test. The Kolmogorov-Smirnov test was used to check the normality of data.

RESULTS

The results showed no significant difference in severity of pain (p = 0.25) and anxiety (p = 0.37) between the two groups on the first day, before the intervention. In the following days, the results showed no significant difference between the two groups in the second and third treatments after intervention . However, the mean pain scores showed a significant difference between the two groups in the forth (p = 0.005), fifth (p = 0.001), and sixth (p = 0.001) days after intervention. Anxiety scores also showed a significant difference between the two groups on the fourth (p = 0.01), fifth (p = 0.001), and sixth (p = 0.001) days.

CONCLUSIONS

Our results showed foot reflexology is an appropriate and safe intervention for management of pain and anxiety of burn patients. Therefore, it can be used as a complementary method alongside other methods.

Adherence to lifestyle changes after coronary artery bypass graft: Outcome of preoperative peer education

OBJECTIVE

This study was done to investigate the effect of preoperative peer education on patients' adherence to medication and lifestyle changes after Coronary Artery Bypass Graft (CABG).

METHODS

In this randomized clinical trial, the peers of CABG patients conducted preoperative educational sessions at the ward in groups of 4-5 (n = 36) while the control group (n = 34) received routine education by a nurse. Adherence of both groups to medication and recommendations for lifestyle modification including physical activity, smoking, and diet was measured one and two months after discharge.

RESULTS

A multivariate analysis of co-variance showed the significant effect of peer education on adherence (F = 32.586, p < 0.001; η² = 0.671). Univariate ANCOVA revealed a significant difference in adherence to diet between the two groups (F = 62.316, p = 0 0.0001; η² = 0.482). Based on the repeated measures ANOVA, peer education significantly improved the CABG patients' adherence to diet (F = 55.373, p = 0.0001) and their total adherence (F = 9.911, p = 0.002) compared to the control group.

CONCLUSION

Preoperative peer education had a significant effect on improving CABG patients' adherence to lifestyle changes after hospital discharge.

PRACTICE IMPLICATION

Peer education can be used as an effective method to improve the CABG patients ' adherence to lifestyle changes.

The effects of chromium and vitamin D3 co-supplementation on insulin resistance and tumor necrosis factor-alpha in type 2 diabetes: a randomized placebo-controlled trial

The current study was conducted to assess the effects of simultaneous usage with vitamin D₃ and chromium picolinate (CrPic) supplementations on homeostasis model assessment of insulin resistance (HOMA-IR), fasting blood glucose (FBS), hemoglobin A1c (HbA1c), tumor necrosis factor-α (TNF-α), and lipid profile in type 2 diabetes mellitus (T2DM). Ninety-two patients with T2DM were randomly allocated to the following 4 groups for 4 months: (I) placebo of vitamin D₃ (n = 23); (II) vitamin D₃ supplement at a dose of 50 000 IU/week (n = 23); (III) CrPic supplement at a dose of 500 μg/day (n = 23); and (IV) both vitamin D₃ at a dose of 50 000 IU/week and CrPic at a dose of 500 μg/day (n = 23). HOMA-IR levels increased significantly in groups I and II after the intervention. However, this increase in group I was significantly higher than that in group II after the treatment. HOMA-IR levels were controlled in groups III and IV during the intervention. TNF-α decreased significantly in groups II, III, and IV after the intervention. FBS, HbA1c, and lipid profile did not change significantly in total groups after the intervention. It seems that chromium and vitamin D₃ co-supplementation are probably effective in controlling HOMA-IR by decreasing TNF-α in T2DM. Novelty Chromium alone and/or in simultaneous pretreatment with vitamin D₃ is more effective than vitamin D₃ in controlling HOMA-IR in T2DM. Chromium and vitamin D₃ alone and/or in simultaneous pretreatment decrease TNF-α in T2DM.

Prediction of academic achievement based on learning strategies and outcome expectations among medical students

BACKGROUND

One of the most important indicators of the effectiveness of teaching can be the academic achievement of learners, which can be influenced by different factors such as learning methods and individual motivations. The purpose of this study was to determine the ability of predicting academic achievement based on learning motivation strategies and outcome expectations based on a theoretical model.

METHODS

This descriptive-analytic study was conducted with the participation of 380 male and female students of nine faculties of medical sciences of Shahid Beheshti University of Tehran. Multi-stage sampling along with the questionnaire of motivational strategies for learning and student outcome expectation scale were used for data collection. The college grade point average (CGPA) of students' past grades was considered as the academic performance variable. Data analysis was performed using Structural Equation Modeling (SEM) in AMOS software.

RESULTS

The mean score of the structure of learning strategies, motivational strategies, outcome expectations, and students' GPA did not show significant statistical differences in terms of gender, marital status, residence location, field of study, and educational level. There was a direct and significant relationship between the motivational strategies' structures (R = 0.193, p < 0.001) as well as learning strategies (R = 0.243, p < 0.001) and the CGPA, while there was no relationship between outcome expectations and CGPA. Path analysis revealed that self-regulating learning strategies and motivational strategies can predict the academic achievement of these students.

CONCLUSIONS

Considering the importance of active and independent learning among medical students, it is necessary for lecturers to use interactive and student-oriented patterns of teaching. Also, students should become familiar with self-regulating learning skills to better understand the information they receive.

Cross-cultural psychometric properties of the Persian version of the Measure of Processes of Care for Service Providers questionnaire

Background

The Measure of Processes of Care is the most widely used tool for measuring family-centredness and perceptions of the care process. This study assessed the psychometric properties of the Persian language version of the Measure of Processes of Care for Service Providers questionnaire.

Methods

In a cross-sectional study, the Measure of Processes of Care for Service Providers questionnaire was translated three times based on a backward–forward method. The Persian version of the Measure of Processes of Care for Service Providers was used with 150 health providers in Iran. The Pearson correlation coefficient, Cronbach alpha and interclass correlation coefficient were used for reliability analysis. Content validity index and content validity ratio and confirmatory factor analysis was used for validity assessments.

Results

The test-retest correlation was higher than 0.95 and the interclass correlation coefficient was higher than 0.8 in all domains. The consistency coefficient was calculated as r=0.989 and the Cronbach alpha calculated as 0.994, which varied from 0.978 to 0.994. The content validity index average was 0.97, which varied from 0.90 to 0.99. Moreover, the content validity ratio average calculated 0.726 and ranged from 0.60 to 0.95. The goodness of fit index was acceptable as CMIN =χ2: 411.52, df; 280, P<0.001, CMIN/df; 1.47, root mean square error of approximation: 0.056; P value: 0.19, goodness of fit index and Tucker–Lewis index was 0.951 and 0.938 respectively.

Conclusion

The Persian translation of the Measure of Processes of Care for Service Providers questionnaire is a standard tool for assessing family-centred care with acceptable reliable and valid. It could be used in all health, clinical and rehabilitation centres to assess family-centred care in health care providers and can be an incentive to improve the quality of family-related services.

Determining the TSH reference range in national newborn screening program for congenital hypothyroidism

Objective: Since the initiation of the thyroid screening program in Iran in 2005, 5 mIU/L has been selected as the threshold for thyroid stimulating hormone (TSH) for screening for congenital hypothyroidism. Given the specific disease pattern in the region and current controversies of the TSH cutoff point, a new cutoff point has been proposed in this study.Methods: This study was conducted on the existing database of the screening program consisting of 127,112 neonates in Markazi Province, center of Iran, during 2006-2012. Data on 614 referred neonates consisting of 414 neonates diagnosed of having hypothyroidism and 200 screened healthy neonates, were analyzed. The heel prick test had been done on the studied neonates to determine the TSH levels. The receiver-operator characteristic (ROC) curve and diagnostic values were used for data analysis.Results: The 5-mIU/L cutoff point in the study had a sensitivity and specificity and AUC of 86.5, 10 and 47%, respectively. Among the eleven selected cutoff points, 6.5 mIU/L had the appropriate sensitivity, specificity and AUC (58.9, 56.5 and 57%, respectively), negative and positive likelihood ratios (0.73 and 1.35, respectively).Conclusion: Given the very low specificity of the 5-mIU/L cutoff point for referral and with respect to the high rate of referrals and many false positive cases, we suggest to use the 6.5-mIU/L cutoff point which is more suitable.

Cross-Cultural Adaptation Of The Persian Version Of Test Of The Adherence To Inhalers (TAI)

PURPOSE

Despite the importance of using inhalers concerning chronic obstructive pulmonary disease (COPD), patients generally have problems regarding adherence to medication regimen. The first step in understanding medication adherence is its assessment which requires a reliable tool. The aim of this study was to translate and perform the psychometric assessment of Test of Adherence to Inhalers (TAI).

PATIENTS AND METHODS

In this cross-sectional study, the 10-item TAI was utilized. Patients with COPD referring to Amir-al-Momenin and Vali-Asr hospitals in Arak, Iran, were the study population. The tool was translated using forward-backward translation, and its validity was evaluated via face validity, content validity, and concurrent validity. The reliability of the tool was assessed using test-retest and Cronbach's alpha.

RESULTS

A total of 100 patients with COPD participated in the study, where the results showed that the tool has a good face validity. The CVR was 0.83, the CVI was 0.95, and the concurrent validity with General Medication Adherence Scale (GMAS) was moderate which was not significant (r = 0.613, p = 0.06). The results of the reliability test further showed that in the test-retest, Pearson correlation coefficient was 0.986, ICC was 0.972, and Cronbach's alpha was 0.986.

CONCLUSION

The tool was translated to Farsi language, with the results indicating that Farsi TAI is a valid and reliable tool for measuring inhaler adherence in patients with chronic pulmonary disease.

Effects of coenzyme Q10 supplementation on serum values of adiponectin, leptin, 8-isoprostane and malondialdehyde in women with type 2 diabetes

Patients with type 2 diabetes mellitus (T2DM) have been known to be suffering from coenzyme Q10 (CoQ10) deficiency which results in some complications in them. The purpose of this clinical trial study was to evaluate the effects of CoQ10 supplementation on serum values of adiponectin (A), leptin (L), 8-isoprostane, malondialdehyde (MDA), the A/L ratio in women with T2DM. Sixty-eight women with T2DM were enrolled in the current study and were randomly divided into drug (n = 34) and placebo (n = 34) groups who were consuming 100 mg CoQ10 and 100 mg cellulose acetate per day for 12 weeks, respectively. Measurements were performed at the beginning and after the intervention. Serum values of adiponectin (p = .001) and the A/L ratio (p = .001) were increased while values of leptin (p = .041), MDA (p = .023), 8-isoprostane (p = .004) were decreased significantly in drug group after intervention. This study had shown that CoQ10 supplementation in women with T2DM was effective in elevation of adiponectin and the A/L ratio and reduction of leptin, MDA and 8-isoprostane which could result in improving insulin resistance and modulating oxidative stress situation.

Reduction in maternal serum values of glucose and gamma-glutamyltransferase after supplementation with alpha-lipoic acid in women with gestational diabetes mellitus

AIM

Alpha-lipoic acid (ALA) is a short chain fatty acid which has a key role in energy production. ALA is also known as a universal antioxidant. The aim of the present study was to explore the effects of ALA supplementation in women with gestational diabetes mellitus.

METHODS

A randomized double-blind placebo-controlled clinical trial study was designed. Women with gestational diabetes mellitus (n = 60) during 24-28 weeks of gestation were selected and divided randomly into drug (n = 30) and placebo (n = 30) groups. Drug group supplemented with ALA (100 mg/day) for 8 weeks. The biochemical markers were measured before and after the intervention and considered significant at a P-value less than 0.05.

RESULTS

Maternal circulating values of fasting blood sugar (P < 0.001), gamma-glutamyltransferase (P < 0.001) and alanine transaminase (P = 0.031) were decreased in the drug group after the intervention. However, values of urea, creatinine, uric acid, aspartate transaminase and alkaline phosphatase were not changed significantly after the trial.

CONCLUSION

The present study has shown that supplementation with 100 mg/day of ALA had some beneficial effects on glucose metabolism and liver function in women with gestational diabetes mellitus.

The evaluation of the effect of metformin on breast fibrocystic disease

BACKGROUND

Fibrocystic changes (FCC) is the most common benign breast disease. The main pathophysiologic mechanism of FCC, excessive cell proliferation in response to monthly estrogen and progesterone changes. Regarding to antiproliferative of metformin, the aim of this study is the evaluation of the effect of metformin on FCC in women who were referred to gynecology clinics of ArakMETHODS:This study is a double blind placebo control randomized clinical trial. At the first among women who were referred to gynecology of Arak, 186 women with FCC between 18-40 years were selected. The women were randomly classified into three groups. The first group took metformin and the second group as placebo group took vitamin E and the third group did not take any drug during six months. All groups were compared in clinical symptoms based on visual analogue scale (VAS) and the sonographic data also were recorded and compared. Data analysis was performed by unilateral variance, student t and Chi-square.

RESULTS

The three groups were not different in aspect of mean of the cysts number, cyst size, tenderness and discharge from breast before the intervention, but after the intervention, there was a significant decrease in metformin group (p value < 0.001) based on variance analysis test. There was not a meaningful difference of pain and the location of cysts between the groups after the intervention.

CONCLUSIONS

The present study showed that metformin is effective in treatment of FCC and decreasing of clinical symptoms and imaging items.