Health-related quality of life in women with breast cancer in Iran : a methodological and clinical study

Background: Breast cancer is the most common cancer in women in Iran and is the most common cancer in women both in the developed and the developing world. Living with breast cancer often involves making fundamental changes in life. The breast cancer illness trajectory may negatively affect various dimensions of the patients’ health-related quality of life (HRQoL), but may also vary greatly between individuals. The main aim of the present thesis was to investigate HRQoL and its determinants as well as to study coping abilities in women with breast cancer living in Iran in comparison with women without breast cancer before final diagnosis and 6 months later. Method: The thesis is based on four studies. The first two studies are methodological and include five self-rated psychometric instruments for the Persian language: Health Index (HI), Sense of Coherence (SOC) scale, Spirituality Perspective Scale (SPS), Brief Religious Coping (RCOPE) scale and SF-12 Health Survey version 2 (SF-12v2). The psychometric tests were given to a healthy sample of Iranian population (n=333). In the third study the five instruments were applied at the pre-diagnosis phase (T1) and 6 months later (T2) in a sample of women with breast cancer (n = 162) and in a control group of women seeking mammography who were subsequently diagnosed as not having breast cancer (n= 639). In the fourth study, using the same samples as in Study III (women with breast cancer and controls), the mediating effect of SOC was investigated. Results: Almost all hypotheses tested for validity were confirmed. An exploratory factor analysis and structural equation modeling for the SF-12v2 verified a two-factor structure (a physical component summary and a mental component summary) in accordance with the original factor structure. The reliability of the instruments as measured by internal consistency and intra-class correlations was satisfying. When compared with the control group, the Iranian women with breast cancer rated impaired physical functioning, fatigue and financial difficulties most prominent during the first 6 months after pre-diagnosis. At the same time, the patients with breast cancer improved their perception of global quality of life and emotional functioning. The most important predictors of the HRQoL dimensions were SOC followed by baseline ratings of the respective dimensions. Furthermore, SOC mediated the role of baseline values of HRQoL to follow-up HRQoL values after 6 months. The concept of SOC was a stronger predictor of HRQoL than religious coping and spirituality. Conclusion: The SOC, HI, SPS, Brief RCOPE and SF-12v2 were found to be psychometrically sound instruments, implying that they are suitable for use in health surveys in an Iranian population. When planning nursing care for women with breast cancer in Iran, it is important to integrate HRQoL measures early in the illness trajectory. Our findings suggest that focus should be on physical functioning, fatigue and financial difficulties. As in other cultures, the concept of SOC seems to be applicable to the Iranian context and thus should be considered in individual valuation of coping ability along with religious coping and spirituality

Effect of Post-Hospital Discharge Follow-up on Health Status in Patients with Burn Injuries: A Randomized Clinical Trial

Background: Patients with burn injuries still face various burn-related challenges after being discharged from the hospital. Hence, a follow-up program for such patients is essential. The present study aimed to evaluate the health status of burn victims after 1.5 months follow-up. Methods: The present randomized clinical trial was of a pretest-posttest design, carried out in Kermanshah (Iran) from July 2016 to September 2017. A total of 117 participants were recruited out of which 86 were included in the analysis. The participants were randomly assigned into two groups, namely the intervention group (N=42) and the control group (N=44). All participants were evaluated both at the time of hospital discharge and at 1.5 months post-discharge. The follow-up plan for the intervention group included home visits, telenursing, and referral to specialists or health education centers. To evaluate the physical and psychological status of the participants, five different instruments were used; namely the Burn Specific Health Scale-Brief (BSHS-B), the General Health Questionnaire-28 (GHQ-28), the Brief Pain Inventory (BPI), the Vancouver Scar Scale (VSS), and the Visual Analogue Scale (VAS). All statistical analyses were performed using the SPSS software (version 17.0). Data were analyzed using the Chi-square test, independent t-test, and paired t-test. P<0.05 was considered statistically significant. Results: The mean score of the BSHS-B questionnaire at both the time of discharge and 1.5 months post-discharge follow-up for the control and intervention groups was 61.22±19.07, 57.14±18.92; 83.70±24.73 and 105.16±29.17, respectively. There was a significant difference between the groups at 1.5 months post-discharge follow-up (P<0.001). At 1.5 months, the VSS score was 5.16±1.68 and 6.77±3.46 for the intervention and control groups, respectively. The GHQ-28 score was 28.69±12.39 and 40.79±16.20 for the intervention and control groups, respectively. The VAS and BPI scores of the control group were 5.56±3.11 and 21.93±29.25, respectively. For the intervention group, these scores were 4.85±3.49 and 15.61±27.47, respectively. There was a significant difference between the groups as to the GHQ and VSS scores (P<0.05). However, no significant difference was noted in the BPI and VAS scores (P<0.05). Conclusion: Health status, psychological status, and scar management were improved due to post-discharge follow-up. However, burn patients required continued care for pain, psychological health, and itching problems. Trial Registration Number: IRCT2016110630712

The Clinical Nature of Medical-Surgical Nursing Care

Introduction: Integration of theoretical knowledge and nursing practice has led to the creation of four central concepts in nursing including individual, health, nursing, and environment. Currently, greater emphasis is placed on the two concepts of health and care as the core of nursing. Thus, the purpose of the present qualitative study was to explain the concept of clinical care in internal-surgical nursing and its changes through time. Method: This study was part of an extensive grounded theory research on 14 clinical nurses, clinical educators, and nursing students of the School of Nursing and Midwifery, Shahid Beheshti University, Tehran, Iran. The participants were selected, first, using purposive sampling method, and then, theoretical sampling. Data were collected through individual semi-structured, in-depth interviews. Data were codified using MAXQD 2007 software (VERBI GmbH, Berlin, Germany) and analyzed using grounded theory approach (Strauss & Corbin, 1998). Results: Data analysis revealed the 3 main themes of "essence of care in internal-surgical nursing", "clinical origin of care", and "the decline in nursing". Moreover, 9 subcategories were extracted including "clinical essence of internal-surgical nursing", "patient-centered care", "peaceful conscience of nurses", "meeting the basic needs of the patient", "perception of the patient", "specialization", "alienation with role", "detachment from clinical care", and "dependency". Conclusion: Care is the essence of nursing, in particular internal-surgical nursing, and the clinical environment is the care delivery site. The changes and challenges in providing nursing care necessitate the use of moral approaches, such as designing targeted educational programs and a student-centered curriculum, with emphasis on moral conscience Keywords: Care, Medical-surgical nursing, Clinical practice, Grounded theory, Qualitative researc

Cancer Stigma and its Consequences and Influencing Factors in Iranian Society: A Qualitative Study

Introduction: Stigma refers to a set of negative attitudes, beliefs, behaviors, and thoughts in dealing with a person who has a chronic disease or some health problems. Cancer is one of the diseases associated with stigma. Stigma causes harmful psycho-social effects for the affected person and family members and is considered an obstacle in disease screening and control programs. Accordingly, this study aimed to explore the nature of cancer stigma and its consequences and influencing factors in Iranian society.Methods: A total of 14 people including cancer patients, their families, and healthcare staff participated in this qualitative study. The participants were selected using purposive sampling and the data were collected through semi-structured interviews. The resulting data were analyzed using conventional content analysis and with MAXQDA software (version 10).Results: The content analysis revealed four themes including cancer as a terrifying and pitiful disease, identity crisis/psychosocial disintegration, disease complexity, and public unawareness and community problems.Conclusion: There are many negative beliefs and stereotypes about cancer and affected people, which are exacerbated by public unawareness and lack of sufficient information about cancer, as well as lack of comprehensive support. These beliefs and stereotypes adversely affect the quality of life of affected people. Following the findings of the study, some interventions need to be implemented to reduce stigma, increase the quality of life, and improve the treatment process for cancer patients

Evidence-based review in the field of developing critical appraisal tools for quantitative studies

Background & Aim: Selection of an appropriate critical appraisal tool is an important part of evidence-based practice. The aim of the present study was to do a systematic review of articles according to existing evidence in databases in the field of developing critical appraisal tools for quantitative studies from 2006 to 2016. Materials & Methods: A systematic review was performed on the critical appraisal tools for quantitative studies between 8 to 12 January 2016 in the PubMed, ProQuest, Ovid, Web of Science, Scopus and Cochrane databases using keywords in the MeSH and based on inclusion and exclusion criteria. Results: Of the 1100 retrieved articles, 19 articles were only remained in the study. Workshop, Delphi technique, a panel of experts and exploration method have been used for development of the critical appraisal tools for observational studies (STROBE, STROBE-NI, RECORD, STROME-ID, STROBE-nut AXIS, STROBE-ME, CORE), clinical trials studies (CONSORT and different types, STRICTA, SPIRIT, CA of RCTs of NPs), interventional studies (QI-MQCS), case studies (CARE and SCARE). Also, a general assessment tool (CAT) and a special tool for assessment of the psychometric characteristics of the studies (COSMIN) were presented. Conclusion: A number of useful critical appraisal tools have been identified in this review; however, the validity and reliability of the tools did not show enough attention in these studies. Researchers and referees should be aware of the selection of a simple, valid and reliable critical appraisal tool during the writing of the quantitative articles or evaluation of them can be a useful guide

The Iranian SF-12 Health Survey Version 2 (SF-12v2): Factorial and Convergent Validity, Internal Consistency and Test-Retest in a Healthy Sample

Objectives: Within the context of Health-Related Quality of Life studies, it was necessary to translate and evaluate the psychometric properties of the SF-12 Health Survey version 2. The aim of this study was to investigate the factorial structure, convergent validity and reliability of this instrument in a healthy Iranian sample, following translation and establishment of content and face validity. Methods: In this cross-sectional study the translated instrument was administered together with the Sense of Coherence Scale and Health Index in a convenience sample of healthy people (n=289) aged 18 to 76 years old between June and September 2006. A test-retest was conducted one month later. Results: Content Validity Index for Scale (85.6%) and face validity of the instrument were acceptable. The results of Exploratory Factor Analysis and Structural Equation Modeling by four models verified the existing two-factor structure, a physical and a mental component summary. All models exceeded the goodness of fit indices and showed a resemblance with the original instrument, except for models 3 and 4 (allowing cross-loadings). Although in these two models the General Health item and scale was loaded to the mental component rather than the physical component, construct validity of the instrument was confirmed. Also, physical and mental component summaries were significantly (P<0.001) correlated to the Sense of Coherence Scale (r=0.27, r=0.68) and Health Index (r=0.49, r=0.67). Cronbach&rsquo;s alpha values and the intra-class correlation coefficients were &ge;0.70 and &ge;0.60, respectively. Discussion: The Iranian SF-12 Health Survey version 2 was a psychometrically sound instrument, implying that it is suitable for use with large-scale surveys in Iranian population, both in clinical and rehabilitation settings or at a public level

Designing and psychoanalysis: A comprehensive questionnaire on coping with domestic violence against women in Iranian society

Background: Domestic violence is the third sociopathology after addiction and child abuse in Iran. Fifty-six percent of Iranian women in the range of 17-32 years old are exposed to the highest domestic violence. Objective: The aim of this study was to design and psychoanalyze a comprehensive questionnaire on coping with domestic violence against women in Iranian society. Methods: This study was carried out on a random sample of women exposed to domestic violence and referred to the health and care center of Shahid Beheshti University of Medical Sciences in Tehran, and Forensic Medical Centers in Urmia city (Iran), in 2017. Two hundred questionnaires were distributed among the participants. One hundred sixty-eight questionnaires were returned to the researchers for data analysis. Eight of those were excluded from the analysis because of incompleteness. Finally, exploratory factor analysis was performed. Results: After reviewing the literature, a questionnaire with 32 items was developed. Content validity ratio (0.95) and content validity index (0.97) were obtained. The results of exploratory factor analysis indicated that the questionnaire explained 69.34% of the data variance. Cronbach's alpha coefficient, and test-retest methods were used for determining the reliability and the obtained value, which were 0.82 and 0.81, respectively. Conclusion: Validity and reliability of the questionnaire with 32 items were confirmed. The tool can be utilized to measure how women cope with domestic violence

Knowledge, Attitude and Practice of Osteoporosis Prevention in Teen Girls in Quchan

Background and Aim: The main principle in osteoporosis prevention is to understand the mindset, general lifestyle&nbsp;and daily routines of individuals. Since the years of childhood and adolescence are the golden time to increase bone mass, the aim of this study was to determine the knowledge, attitude and practice&nbsp; related to prevention of osteoporosis in adolescent girls. Materials and Methods: This descriptive cross-sectional study was conducted on 209 adolescent girls selected by a multi-stage sampling design from girlish high schools in Quchan City in 2017. The researcher-made questionnaire consisted of 38 questions and four sections containing demographic characteristics, knowledge, attitude and pracice of adolescents in the prevention of osteoporosis. After performing the validity and reliability&nbsp; the participants completed the questionnaires in a self-reported manner with informed consent. Data were analyzed by SPSS software version 18 using descriptive and inferential statistics. Results: Most of the adolescent girls reported moderate awareness (59.3%), attitude in a good level (75.1%), and moderate practice (66.5%). There was a significant relationship between attitude in prevention of osteoporosis and mother's job (p = 0.045). Conclusion: According to the results of the study, which showed that adolescent girls had a moderate level of knowledge and practice despite having good attitudes, the need for educational programs through mass media and conducting educational classes was necessary, as well as providing free sports facilities and Careful monitoring of girls' nutrition in schools is another important measure

A systematic review on clinical guidelines of home health care in heart failure patients

Abstract Background “Guidelines for the care of heart failure patients at home support safe and effective evidence-based practice. The aims of the present study were: [1] to identify guidelines addressing the care at home for adults with heart failure and [2] evaluate the quality of the guidelines and the extent to which they address eight components of home-based HF disease management.” Methods A systematic review was conducted of articles published between 1st of January 2000 to 17th of May 2021 using the databases of PubMed, Web of Science, Scopus, Embase, Cochrane, and nine specific websites for guideline development organisations. Clinical guidelines for HF patients with recommendations relevant to care provision at home were included. The results were reported according to the Preferred Reporting Items for Systematic Reviews (PRISMA-2020) criteria. The quality of included guidelines was evaluated using the Appraisal of Guidelines for Research and Evaluation-II (AGREE-II) by two authors independently. Guidelines were evaluated for their coverage of eight components of HF care at home, consisting of integration, multi-disciplinary care, continuity of care, optimized treatment, patient education, patient and partner participation, care plans with clear goals of care, self-care management and palliative care. Results Ten HF guidelines, including two nursing-focused guidelines and eight general guidelines were extracted from 280 studies. After evaluation of quality by AGREE-II, two guidelines obtained the highest score: “NICE” and the “Adapting HF guideline for nursing care in home health care settings. Five guidelines addressed all eight components of care at home while the others had six or seven. Conclusions This systematic review identified ten guidelines addressing care at home for patients with HF. The highest quality guidelines most relevant to the care at home of patients with HF are the “NICE” and “Adapting HF guideline for nursing care in home health care settings” and would be most appropriate for use by home healthcare nurses