The effects of breathing techniques on pain intensity of burn dressing

زمینه و هدف: درد سوختگی یکی از شدیدترین و مداوم ترین انواع درد می باشد و یکی از زمان هایی که معمولاً بیماران سوخته بیشترین میزان درد را تجربه می کنند، زمان تعویض پانسمان است. مطالعه حاضر با هدف تعیین تاثیر تکنیک های تنفسی بر شدت درد پانسمان در بیماران مبتلا به سوختگی صورت گرفت. روش بررسی: در این مطالعه کارآزمایی بالینی تعداد 68 بیمار مرد مراجعه کننده به بخش سوختگی مرکز آموزشی درمانی آیت اله کاشانی شهرکرد از طریق نمونه گیری آسان هدفمند انتخاب و سپس بطور تصادفی در یکی از گروه های مداخله یا کنترل توزیع شدند. گروه مداخله تحت مداخله تکنیک های تنفسی طی انجام پانسمان قرار گرفتند و برای گروه کنترل مراقبت روتین به اجرا در آمد. شدت درد پانسمان سوختگی در دو گروه با استفاده از ابزار سنجش درد دیداری (Visual analogue scale) ارزیابی و مقایسه گردید. یافته ها: میانگین نمره شدت درد در بدو پانسمان سوختگی در گروه مداخله 2/02±6/32 و در گروه کنترل 1/98±5/90 بود که پس از مداخله نمره شدت درد در گروه مداخله به 1/46±3/66 و در گروه کنترل به 1/38±4/80 کاهش یافت که این کاهش معنادار بود (0/04=P). نتیجه گیری: بکارگیری تکنیک های تنفس می تواند در کاهش قابل توجه شدت درد پانسمان سوختگی مؤثر باشد؛ لذا به پرستاران بخش های سوختگی و اورژانس پیشنهاد می گردد جهت تخفیف درد ناشی از پانسمان سوختگی، علاوه بر استفاده از داروهای ضد درد، بیماران را تشویق به انجام تمرینات تنفسی مکرر طی انجام پانسمان بنمایند

The impact of illicit drug use on Spontaneous Hepatitis C Clearance: Experience from a large cohort population study

Background and Aims: Acute hepatitis C infection usually ends in chronic infection, while in a minority of patients it is spontaneously cleared. The current population-based study is performed on a large cohort in Golestan province of Iran to examine the demographic correlates of Spontaneous Hepatitis C Clearance. Methods: Serum samples used in this study had been stored in biorepository of Golestan Cohort Study. These samples were evaluated for anti hepatitis C Virus by third generation Enzyme-linked immunosorbent assay (ELISA). Subjects who tested positive were then invited and tested by Recombinant Immunoblot Assay (RIBA) and Ribonucleic Acid Polymerase Chain Reaction test (PCR). If tested positive for RIBA, subjects were recalled and the two tests were re-done after 6 months. Those subjects who again tested positive for RIBA but negative for PCR were marked as cases of spontaneous clearance. Results: 49,338 serum samples were evaluated. The prevalence of Chronic Hepatitis C Virus (CHCV) infection based on PCR results was 0.31. Among those who had acquired hepatitis C, the rate of SC was 38. In multivariate analysis, illicit drug use both Injecting Use (OR = 3.271, 95 CI: 1.784-6.000, p-value<0.001) and Non-Injecting Use (OR = 1.901, 95 CI: 1.068-3.386, p-value = 0.029) were significant correlates of CHCV infection versus SC. Conclusions: Illicit drug use whether intravenous or non-intravenous is the only significant correlate of CHCV, for which several underlying mechanisms can be postulated including repeated contacts with hepatitis C antigen. © 2011 Poustchi et al

Model-driven decision support system for estimating number of ambulances required during earthquake disaster relief operation

Most of human life has been encountered danger due to natural disasters nowadays. One of these natural disasters that endanger human lives and which causes lot of damages is earthquake. A proper emergency response after an earthquake happening is important and has high priority in earthquake emergency management to reduce number of damages. Decision making for critical resources in the phase of response, is one of the main concerns for managers. Ambulance, as one of the critical resource that can help to reduce earthquake losses and costs, needs to be planned. Confusion in the number of victims in the early stages of earthquake, access complexity to the required data of different organizations by the pressing time, complicated nature of estimation, diversity of models and limitation of time for decision making are the main problems associated with estimating ambulances during earthquake disaster which makes estimation too difficult. In addition, there is a call for research in determining the number of required ambulances during earthquake emergency management, due to high error in estimating the number of ambulances in the current methods, which leads to unnecessary expenses and thereby helping to ensure that disaster sites are not overcrowded with emergency workers impeding each other's effectiveness. Such complexity suggests the introduction of Decision Support System (DSS). More accurate estimation of the number of required ambulances using a decision support system can help managers to speed up the process of decision making and thus reducing error and costs. Since the number of ambulances needed during a disaster is directly proportional to the number of victims requiring hospital treatment and in order to reach the first objective of this study, factors determining the number of human casualties in earthquake disaster i.e. population, modified Mercalli, age, time, building occupancy and gender are selected as the most relevant factors which have high probability in creating human casualties. The collected data from various relevant sources is used in proposing the model of this research. After testing different approaches, Fuzzy rule-based approach is being used, after defining the rules for each aforementioned factors and optimization is conducted in order to minimize the error for estimating the number of human casualties. Finally, by using de Boer formula and obtained number of human casualties, the number of required ambulances is estimated accurately. The results indicate that the error is decreased by more than 50% in the proposed method. A prototype of Model-Driven Decision Support System was developed based on the proposed model that can be used to aid emergency response planners for their decision making process prior to take any action during earthquake emergency management

Developing of the appropriateness evaluation protocol for public hospitals in Iran

Background: Employment of utilization review instruments is a method for managing costs and efficiency in the healthcare systems. Objectives: This study developed an instrument for measuring the level of inappropriate acute hospital admissions and days of care in Iran. Patients and Methods: The American version of the Appropriateness Evaluation Protocol (AEP) was modified, using the agreement method, by a multidisciplinary group of physicians. We conducted a retrospective descriptive study of 273 randomly selected patients admitted to Imam Khomeini Hospital of Tehran University of Medical Sciences in Tehran, Iran. For the reliability study, two nurses were asked to review patients� medical records using the instrument. Validity was appraised by pairs of clinicians, including two general surgeons, two internists and two gynecologists. The degree of consensus between the three pairs of clinicians was compared with that of the nurses. Results: Inter-rater and intra-rater reliability testing revealed an excellent level of consensus between the two nurses employing the AEP in all the studied departments. Overall agreement was > 92, while the specific appropriate agreement and specific inappropriate agreement were > 88 and > 83, respectively. External validity testing of the instrument yielded a sensitivity > 0.785, specificity > 0.55, and positive and negative predictive values > 0.775 and > 0.555, respectively. The kappa statistic for the nurses who applied the AEP and clinicians using personal judgment were perfect (k > 0.85) and substantial (k > 0.68), respectively. Conclusions: The results illustrate that the Iranian version of the AEP (IR-AEP) could be a reliable and valid instrument for assessing the level of inappropriate acute hospital admissions and days of care in the Iranian context. © 2015, Iranian Red Crescent Medical Journal

Behavioral feasibility of the clinical nursing information system

Background: Analysis of humanitarian issues affecting the implementation time of information systems to increase the acceptance of these systems is essential. Objective: The aim of this study was to assess the behavioral feasibility of the clinical nursing information system. Methods: An applied cross-sectional study was conducted with 348 nurses in 2015. Data were collected by face to face interviews and a questionnaire containing 33 questions, which were rated on a 5-point Likert scale. Face and content validity of the questionnaire was confirmed, and its reliability was estimated 0.90 through Cronbach's alpha coefficient. Data were analyzed using chi-square tests and t-test. Results: An average score of behavioral feasibility was 67.44. The rate of supply provided for implementing the clinical nursing information system was 55.2, which was in a semi-favorable level. The necessity of system deployment in the clinical nursing sector had the highest frequency (88.2) and interference of redesigning structures with the current work had the lowest frequency (43.6). Conclusion: The possibility of implementation of the clinical nursing information system in a behavioral dimension is at a semi-favorable level. To increase the acceptance of the system, presenting a new system as a positive change and further training of the nurses is recommended. © 2019 Jeddi et al

The relationship between body image and marital adjustment in infertile women

Introduction: Body image is one of the most important issues in women's mental health and due to its relationship with physical, cognitive and emotional aspects of women’s life; it can predict their healthy or unhealthy behaviors. According to some research reports, women’s negative or positive body image can affect their marital relationships. Considering the impact of infertility on both body image and marital adjustment and the lack of evidence regarding the relationship of these two variables in infertility, this study aimed to investigate the relationship of body image with marital adjustment in infertile women in 2010 in Mashhad. Methods: This correlational study was carried out on 130 infertile women referred to Montaserie Infertility Research Center in Mashhad who were selected through convenient sampling. Research tools were consisted of valid and reliable demographic questionnaire including personal and infertility-related information, modified Younesi Body Image Questionnaire and Spanier marital adjustment scale (DAS) which were completed by subjects. Data analysis was carried out by SPSS software (version 15/5) using t-tests, one way ANOVA, and Spearman and Pearson correlation test. Results: 93/1% of women reported positive body image and 76/9% had high marital adjustment. There was a direct correlation between the overall score of body image with marital adjustment (P<0/001). There was also a direct correlation between the scores of body image subscales including body in loneliness (P= 0/001), real body (P=0/014), public image of body (P=0/016), spouse image of body (P<0/001) and spouse family image of body (P<0/001) with marital adjustment. However, this relationship was not observed between the subscale of ideal body and marital adjustment. Conclusion: The presence of a direct correlation between body image and marital adjustment could guide developing educational or counseling programs particularly for infertile women who suffer from marital disputes. Keywords: Body image, Marital adjustment, Infertilit

Magnetron sputtering technique for analyzing the influence of RF sputtering power on microstructural surface morphology of aluminum thin films deposited on SiO2/Si substrates

In this research, aluminum (Al) thin films were deposited on SiO2/Si substrates using RF magnetron sputtering technique for analyzing the influence of RF sputtering power on microstructural surface morphologies. Different sputtering RF powers (100–400 W) were employed to form Al thin films. The characteristics of deposited Al thin films are investigated using X-ray diffraction pattern (XRD), scanning electron microscopy (SEM), atomic force microscopy (AFM) and Fourier-transforms infrared (FTIR) spectroscopy. The X-ray diffraction (XRD) results demonstrate that the deposited films in low sputtering power have amorphous nature. By increasing the sputtering power, crystallization is observed. AFM analysis results show that the RF power of 300 W is the optimum sputtering power to grow the smoothest Al thin films. FTIR results show that the varying RF power affect the chemical structure of the deposited films. The SEM results show that by increasing the sputtering power leads to the formation of isolated texture on the surface of substrate. In conclusion, RF power has a significant impact on the properties of deposited films, particularly crystallization and shape

Postrenal transplant hemophagocytic lymphohistiocytosis and thrombotic microangiopathy associated with parvovirus B19 infection

Persistent anemia is a known consequence of Parvovirus B19 (B19) infection following renal transplantation. However, to date, no description of B19-related hemophagocytic lymphohistiocytosis (HLH) exists in renal transplant recipients. We report a 24-year-old male kidney recipient, who presented with fever, severe anemia and allograft dysfunction two years following transplantation. Hyperferritinemia, hypertriglyceridemia, elevated serum lactate dehydrogenase, pancytopenia and fragmented red blood cells on the peripheral blood were also noted. Bone marrow examination revealed giant pronormoblasts and frequent histiocytes with intracellular hematopoietic elements, consistent with HLH. Renal allograft biopsy revealed closure of the lumen of glomerular capillaries and thickening of the capillary walls compatible with thrombotic microangiopathy. The presence of anti-B19 IgM antibody and viral DNA in the patient's serum (detected by real-time PCR) confirmed an acute B19 infection. Following high-dose intravenous immunoglobulin therapy, the anemia gradually resolved and renal function improved. As far as we know, this is the first report of B19-associated HLH and thrombotic microangiopathy in a renal transplant recipient. © 2008 The Authors

Neutrino Decays over Cosmological Distances and the Implications for Neutrino Telescopes

We discuss decays of ultra-relativistic neutrinos over cosmological distances by solving the decay equation in terms of its redshift dependence. We demonstrate that there are significant conceptual differences compared to more simplified treatments of neutrino decay. For instance, the maximum distance the neutrinos have traveled is limited by the Hubble length, which means that the common belief that longer neutrino lifetimes can be probed by longer distances does not apply. As a consequence, the neutrino lifetime limit from supernova 1987A cannot be exceeded by high-energy astrophysical neutrinos. We discuss the implications for neutrino spectra and flavor ratios from gamma-ray bursts as one example of extragalactic sources, using up-to-date neutrino flux predictions. If the observation of SN 1987A implies that \nu_1 is stable and the other mass eigenstates decay with rates much smaller than their current bounds, the muon track rate can be substantially suppressed compared to the cascade rate in the region IceCube is most sensitive to. In this scenario, no gamma-ray burst neutrinos may be found using muon tracks even with the full scale experiment, whereas reliable information on high-energy astrophysical sources can only be obtained from cascade measurements. As another consequence, the recently observed two cascade event candidates at PeV energies will not be accompanied by corresponding muon tracks.Comment: 20 pages, 6 figures, 1 table. Matches published versio