Public and Private Hospital Nurses' Perceptions of the Ethical Climate in Their Work Settings, Sari City, 2011

Background: Nurses’ perceptions of ethical climate patterns have certain undeniable effects on hospitals. There is little evidence of possible differences in this element between public and private hospitals and contributing factors. Objectives: This study investigated whether the perceptions of the ethical climate in nurses’ working in public hospitals differ from that of nurses in private hospitals, and which factors may affect nurses’ perceptions. Materials and Methods: A cross-sectional study of randomly selected registered nurses (n = 235), working in four public hospitals affiliated to Mazandaran University of Medical Sciences, and three private hospitals, was conducted in Sari City, Iran. A self-administered questionnaire, containing demographic characteristics and the Hospital Ethical Climate Survey (HECS), were used to assess registered nurses’ perceptions of public and private hospitals ethical climate. An independent t-test and one-way ANOVA were used to analyze the data. Results: Across the five factors of HECS, the highest and lowest mean scores pertained to managers and physicians, respectively, in both public and private hospitals. Nurses who had a conditional employment situation and those working in pediatric intensive care units showed significantly more positive perceptions of the ethical work climate when compared to their peers (P < 0.05). Although the mean score of ethical work climate in private hospitals (3.82 ± 0.61) was higher than that in public hospitals (3.76 ± 0.54), no significant difference was found (P = 0.44). Conclusions: Hospital managers need to discover better ways to promote safety and health programs for their staff according to nurses’ area of work and their type of units. They should also encourage greater levels of participation in safety-enhancing initiatives in the hospital’s ethical climate, especially in the areas of nurses’ perceptions of their physician colleagues, and for nurses with a conditional employment situation

Does high-dose metformin cause lactic acidosis in type 2 diabetic patients after CABG surgery? A double blind randomized clinical trial

Metformin is a dimethyl biguanide oral anti-hyperglycemic agent. Lactic acidosis due to metformin is a fatal metabolic condition that limits its use in patients in poor clinical condition, consequently reducing the number of patients who benefit from this medication. In a double blind randomized clinical trial, we investigated 200 type 2 diabetic patients after coronary artery bypass surgery in the open heart ICU of the Mazandaran Heart Center, and randomly assigned them to equal intervention and control groups. The intervention group received regular insulin infusion along with 2 metformin 500 mg tablets every twelve hours, while the control group received only intravenous insulin with 2 placebo tablets every twelve hours. Lactate level, pH, base excess, blood glucose and serum creatinine were measured over five 12 h periods, with data averaged for each period. The primary outcome in this study was high lactate levels. Comparison between the 2 groups was made by independent Student’s t-test. To compare changes in multiple measures in each group and analysis of group interaction, a repeated measurement ANOVA test was used

The Effect of Simultaneous Administration of Zinc Sulfate and Ferrous Sulfate in the Treatment of Anemic Pregnant Women

Background: Iron deficiency and its resulting anemia is a common problem among Iranian pregnant women. In spite of iron supplementation program, yet, this problem has not resolved in many parts of the country. Zinc deficiency also is very common in Iran. This study evaluated the efficiency of concomitant zinc and iron therapy in the treatment of anemic pregnant Iranian women.&#13; Methods: A total of 118 anemic women were registered in this randomized controlled trial. Both groups received 100 mg elemental iron daily. The intervention group received an additional dose of 15mg zinc every day for a period of 12 weeks while the control group received placebo. Serum hemoglobin was measured at the beginig of study, after 12 weeks of treatment and at the end of 8 weeks follow-up. Collected data were analyzed with %95 significance level by ANOVA test for comparing baseline characteristics in the two groups and t-test was applied to assess hemoglobin changes in the intervention group.&#13; Results: After 12 weeks of therapy, desirable response was obtained in 78.35% and 93.1% (CI=95%) of anemic women in control and intervention group, respectively which showed a significant difference (P&lt;0.05). Increase in serum hemoglobin just after 12 weeks of treatment was 2.22 ± 0.77 and 1.5 ± 0.66 (gr/dl) in intervention and control group respectively, (P&lt;0.001). Serum hemoglobin differences in the two groups 8 weeks later (step2) when iron alone was administered to both groups were 2.24 ± 0.77 and 1.49 ± 0.66 (gr/dl) respectively . (P&lt;001)&#13; Conclusion: this study clearly demonstrated the efficacy of this inexpensive and simple intervention in the treatment of anemia and prevention of its recurrence in anemic pregnant women.&#13; Key words: Anemia, Pregnant women, Supplement, Isfahan, Zinc sulfate, Ferrous sulfat

Eigenvalues for the Steklov problem via Ljusternic–Schnirelman principle

AbstractThis paper deals with the existence of nondecreasing sequence of nonnegative eigenvalues for the systemsdiv(a(x)|∇u|p-2∇u)=b(x)|u|p-2uinΩ,|∇u|p-2∂u∂n=λc(x)|u|p-2uon∂Ω,by using the Ljusternic–Schnirelman principle, where Ω is a bounded domain in RN(N⩾2)

Evaluation of Clinical Manifestations and Therapeutic and Diagnostic Progression of Dyspepsia in Children Referred to Boo-Ali Hospital of Sari in 2005-2

Background and purpose: Chronic abdominal pain is a common clinical problem in children. Apleys reported the incidence of 10-15% of chronic abdominal pain in school age children, but recent studies reported 20% of that type of pain. The aim of this study was determining the spectrum of clinical manifestations of dyspeptic children and to identify the relation between some clinical symptoms, organic or functional dyspepsia, and long term follow up of functional type.Materials and Methods: This descriptive case series study was done on 232 children between 4 and 18 years of age complaining about chronic abdominal pain chiefly who had referred to pediatric gastroenterology department of Boo-Ali Hospital of sari in 2005-2006. A checklist composed of patient demographic criteria and pain characteristics was prepared. Physical exam and laboratory tests such as AST, ALT, U/A, U/C, S/E, ESR, CBC were performed for all patients. If there were any alarming signs of organic abdominal pain-persistence or recurrence of symptoms and severe disability despite the use of H-blockers-upper GI endoscopies was indicated. Recorded data were analyzed by SPSS software and Chi- square tests.Results: 102 of 232 patients had dyspepsia; 59 were girls (9.2y/o), and 43 were boys (7.5y/o). 65 out of 102 patients had dominant abdominal pain and the rest had flatulence, vomiting and early fullness. 64 of them went under UGI endoscopies. 28 of 64 had mucosal erosion.Conclusion: Because the functional or organic abdominal pain has not unique diagnostic criteria, and the data about pathological change in children are fewer than that of adults we recommend the clinical findings and biochemical change of mucosa for differential diagnosis in children

Comparison of the effectiveness of weekly and daily iron supplementation in pregnant women in rural health centers of Mazandaran province, 1383

Background and purpose: Iron deficiency and its related anemia is a common Iranian pregnant women problem. This study evaluated the efficacy of daily and weekly ferrous sulfate supplementation in pregnant women.Materials and Methods: 150 pregnant women enrolled into this randomized controlled field trial. They were received 50 mg elemental iron daily in control group and 100 mg elemental iron weekly in other group for 12 weeks duration. Serum ferritin and serum hemoglobin was measured at the start and immediately after 12 weeks of the study. Collected data were analyzed with SPSS10 software.Results: After 12 weeks of Iron supplementation, no significant differences were observed in serum hemoglobin (gr/dl) and serum ferritin ( g/dl) levels in daily and weekly groups (p>0.05). Also the frequency of anemia after 12 weeks in two groups was not significantly different (p>0.05).Conclusion: According to the results and tendency of pregnant women to the weekly regime and less consumption of ferrous sulfate pills in this group, weekly regime is reccomended for suplementatio

Effect of intravenous Vitamin C on sleep quality in hemodialysis patients

Background and Objective: Poor sleep quality is common among hemodialysis patients and can potentially predict morbidity, mortality and quality of life in these patients. On the other hand, hemodialysis patients are encountered with vitamin C deficiency. The purpose of this study was to determine the effect of intravenous vitamin C on sleep quality in hemodialysis patients. Materials and Methods: In this double blind randomized clinical trial, 60 qualified hemodialysis patients were gone under investigation in Sari a city located in North of Iran during 2010. Patients randomly allocated in two equal intervention and control groups. The main measured outcome was the Pittsburg sleep quality index (PSQI) which consists of seven components. At the end of each hemodialysis session, Intervention group received vitamin C vial (500mg/5cc) intravenously, three times a week for 8 weeks and control group received normal saline in a same way. Data were collected at pretreatment and after two months of treatment. Data were analyzed by Independent t test, Paired t test, Wilcoxon and Chi-Square tests. Results: The result indicated that the sleep quality improves significantly in vitamin C group but not in control group (P<0.001). Vitamin C caused significant improvement in subjective sleep quality, sleep latency, habitual sleep efficiency and sleep disturbances in intervention group (p<0.05). Also, Global PSQI score of intervention group had a greater improvement than control group. Moreover vitamin C caused significant improvement in subjective sleep quality, sleep latency, habitual sleep efficiency and sleep disturbances in intervention group after treatment (p<0.05). Conclusion: This study showed that intravenous vitamin C can effectively improve sleep quality in hemodialysis patients