Predicting the self-efficacy of patients with stoma based on general health

Introduction: In addition to increasing survival and improving the quality of life of the patient, ostomy surgery leads to mental, psychological and social isolation. Considerably, having a good general health and high self-efficacy is necessary to cope with stressful situations in these patients. In this way, the purpose of this study was to predict self-efficacy based on general health dimensions in patients with ostomy. Materials and Methods: In this cross-sectional study, 100 patients with ostomy referring to the Iranian Ostomy Society were selected through simple and accessible sampling in 2016. Data were collected by questionnaires of demographic, general health, and stoma self-efficacy scale. Results: Most of the patients (68) were under the age of 65 years. The mean and standard deviation of the general health and self-efficacy were 28.3 ± 7.6 and 96.6 ± 15.1 respectively. Pearson correlation test showed a positive and significant correlation between self-efficacy with anxiety/insomnia (r=0.357, P=0.001) and physical symptoms (r = 0.191, P < 0.05) dimension, and a negative and significant correlation between self-efficacy and depression (r =-0.279, P = 0.001). The results of stepwise regression showed that insomnia/anxiety, depression and physical symptoms were able to explain 36.8 of self-efficacy changes in these patients. Conclusion: It is concluded that the findings of this study showed that general health status and its dimensions predict self-efficacy in patients with ostomy. This was especially true in patients with lower levels of education and older. © 2019, Semnan University of Medical Sciences. All rights reserved

Comparative study of the effect of warming at various temperatures on biochemical, hematologic, and hemodynamic parameters during spinal fusion surgery under intravenous anesthesia

Background: Perioperative inadvertent hypothermia (PIH) commonly occurs after major surgical procedures under local or general anesthesia and increases the risk of complications such as organ failure, hypoperfusion, and peripheral vasoconstriction, as well as adverse postoperative outcomes, such as wound infection and increased surgical bleeding. Objectives: We hypothesized that the intra-operative warming may affect these complications and thus, we aimed to compare the most appropriate temperature of the warmer to decrease patients� complications. Methods: The present randomized clinical trial investigated 90 patients undergoing total intravenous anesthesia in posterior spinal fusion surgery, randomly divided into two groups of 45. The warmer was set at 38°C for group �A� during surgery and at 40°C for group �B.� Patient�s demographic characteristics, the serum level of hemoglobin, hematocrit, and platelet counts, mean core temperature, systolic blood pressure (BP), heart rate, and respiratory rate were recorded before and after the surgery. Variables were compared between the two groups at three time intervals (during induction, during operation, and during recovery). Results: The mean temperature was not different between the two groups at the three time intervals. Other laboratory serum tests, vital signs, and oxygen consumption were maintained within the normal range although they did not improve significantly in two groups at the three time intervals. Conclusions: There was no significant difference in warming of the patients during operation at 38 or 40°C to prevent hypothermia-induced complications during induction, operation, and recovery. © 2018, Author(s)

The Jurisprudential Rule of the âExclusive Authority of Imam to Implement Punishmentsâ

This article explains the content, history and evidence for the jurisprudential rule of âExclusive Authority of Imam to Implement Punishmentsâ. According to this rule, which has been known in modern criminal law as the principle of judiciality of punishment, it is only authorized officials who are allowed to become involve in issues related to punishment. Based on convincing evidence from the Holy Qurâan, the tradition of Prophet Muhammad and infallible Imams (p.b.u.them), and the consensus of jurists, this article assumes that the rule exists among other strong and certain Islamic rules. Referring to various jurisprudential texts from different historical periods of fiqh, this article demonstrates that even though the rule has been hardly discussed as an independent rule, the content of the rule along with the concept of social order have been among serious concerns of Muslim jurists from the beginning. In the traditional view, however, the rule has not been accepted as a categorical rule and it is often believed that it might allow for exceptions in certain cases. The article has argued in favor of the unconditionality of the rule and suggested that ignoring the content of the rule in practice is an evident example of ignoring Islamic teachings and would lead to chaos and harm to the security of citizens. Moreover, many other basic Islamic legal institutions like the âprinciple of legalityâ and âpresumption of innocenceâ are meaningful only when this rule is accepted

An European Organisation for Research and Treatment of Cancer phase I study of lapatinib and docetaxel as neoadjuvant treatment for Human Epidermal Growth Factor Receptor 2 (HER2) positive locally-advanced/inflammatory or large operable breast cancer.

BACKGROUND: Lapatinib is an effective anti-HER2 therapy in advanced breast cancer and docetaxel is one of the most active agents in breast cancer. Combining these agents in pre-treated patients with metastatic disease had previously proved challenging, so the primary objective of this study aimed to determine the maximum tolerated dose (MTD) in treatment-naive patients, by identifying acute dose-limiting toxicities (DLT) during cycle 1 in the first part of a phases 1-2 neoadjuvant European Organisation for Research and Treatment of Cancer (EORTC) trial. PATIENTS AND METHODS: Patients with large operable or locally-advanced HER2 positive breast cancer were treated with continuous lapatinib, and docetaxel every 21days for 4 cycles. Dose levels (DLs) were: 1000/75, 1250/75, 1000/85, 1250/85, 1000/100 and 1250/100 (mg/day)/(mg/m(2)). RESULTS: Twenty-one patients were included. Two DLTs occurred at dose level 5 (1000/100); one grade 4 neutropenia ⩾7days and one febrile neutropenia. A further 3 patients were therefore treated at the same dose with prophylactic granulocyte-colony stimulating factor (G-CSF), and 3 patients at dose level 6. No further DLTs were observed. CONCLUSIONS: Our recommended dose for phase II is lapatinib 1000mg/day and docetaxel 100mg/m(2) with G-CSF in HER2 positive non-metastatic breast cancer. The dose of lapatinib should have been 1250mg/day but we were mindful of the high rate of treatment discontinuation in GeparQuinto with lapatinib 1250mg/day combined with docetaxel. No grade 3-4 diarrhoea was observed. Pharmacodynamics analysis suggests that concomitant medications altering P-glycoprotein activity (in addition to lapatinib) can modify toxicity, including non-haematological toxicities. This needs verification in larger trials, where it may contribute to understanding the sources of variability in clinical toxicity and treatment discontinuation