Critical thinking and clinical decision making in nurse‏

BACKGROUND: Today, nurses are exposed to everchanging complicated conditions in health care services, they provide. To be able to cope with these conditions effectively, they should be competent decision makers. Besides, as decision making conditions get more complicated, using critical thinking is a need. The current study was carried out to evaluate the relationship between critical thinking and clinical decision making, in nurses of critical and general care units of hospitals in Isfahan. In addition, it is also aimed to compare the nurses of critical and general units in critical thinking and clinical decision making. METHODS: This is a correlation, descriptive study of cross-sectional type. The participants are 140 nurses; 70 working in critical care unit and 70, working in general units. Sampling method was random stratified sampling and the data was collected using a questionnaire with three sections; containing items on demographic data, clinical decision making and California critical thinking skills test. The validity and reliability of the questionnaire was approved using content validity, test-retest method and internal correlation test. The data was analyzed using variance analysis, Pearson correlation and t-test. RESULTS: The mean score of critical thinking and clinical decision making was 10.61, 63.27 and 10.67, 61.66 for nurses of critical care and general units, respectively. No statistical significant difference between two groups was observed in the area of clinical decision making and critical thinking. In addition, no statistical correlation was observed between the clinical decision making and critical thinking. CONCLUSIONS: The findings of the study demonstrated that the mean score of critical thinking was low in nurses. Probably, it originates from the educational system shortages and also, the professional environment problems. Some experts believe that the reason for lack of correlation between critical thinking and clinical decision making goes back to the absence of appropriate tool to measure the correlatio

Medical imaging modalities: Prevention of unnecessary orders and non-optimized radiation exposure

Magnetic resonance imaging (MRI) uses a constant magnetic field and radio waves, a non-invasive method for examining tissues, organs and the skeletal system. The advantages and disadvantages of MRI is not fully understood. In the computerized tumor (CT) scan, as an invasive method, the x-rays of the body is used for tomography; which different x-ray attenuation coefficient in tissues as well as the reconstruction of images could affect on the scanning of the patient and the received amount of radiation by the patient. However, compared to other radiographical diagnostic methods, CT scan could lead to the exposure of the patients against substantial radiation dosage, which may have several radiobiological effects such as delayed effects of radiation (possible effect) with the result of a variety of cancers, chromosomal failures and potential genetic abnormalities in the future generations. It is recommended that these tests would prescribe for the patients with greater accuracy and caution; with application of magnetic dosimeter for monitoring exposure of people who working with MRI (as its application for X-ray and CT scan)

Pre-Differentiated Embryonic Stem Cell versus Olfactory Ensheathing Cell for Spinal Cord Regeneration after Compressive Injury in Rat

Background: Transplantation approaches are interventions currently available to apply to the devastating problem of spinal cord injury (SCI). Olfactory ensheathing cell (OEC) and embryonic stem cell (ESC) are considered to be promising therapeutic strategies. In this study, we compared the potential use of OECs and neurally pre-differentiated ESCs in contusion spinal cord.Methods: OECs were harvested from olfactory bulb of rats and labeled with Hoescht 33342. ESCs were generated by using feeder free GFP positive CGR8 mouse ESCs and neurally pre-differentiation was induced by retinoic acid (RA) and characterized by different antibodies. SCI was induced by fogarty catheter at T8-T9 level in adult rats. Transplantations were performed 9 days after the injury. Rats were randomly divided into 3 main groups (neurally pre-differentiated ESC, OEC and media as control group). The recovery of gross motor function was evaluated using Basso-Beattie-Bresnahan (BBB) locomotor rating scale on the ninth day post injury and once per week thereafter for 4 weeks after cell transplantation. At 28 days after transplantation, histological assessment including transplanted cell detection in tissue, tissue sparing and myelinated axons was performed.Results: Following transplantation, a significant recovery of hindlimb function according to BBB scale was observed in rats in the transplanted groups compared to control and sham groups (p<0.05). There was no significant difference between transplanted groups four weeks after transplantation. OEC and ESC were found in the tissue after transplantation. In OEC group, many of OECs were detected around and within the cystic cavity that number of these cells was significantly higher in comparison with number of cells in ESC group (p< 0.001).In the site of injury, several cavities were produced that disrupted portions of the gray and white matters. The extent of tissue damage was more severe in the sham and control groups than the other groups. Significantly more spinal tissue was spared in OEC and ESC groups (P < 0.001). No significant difference in percentage of spared tissue was found between sham and control groups or transplanted groups. The percentage of myelinated area was greater in OEC group than in three other groups (p< 0.05) (Figure 5, A). Although the percentage of myelinated area was more in ESC group in comparison with non-treated groups, but this difference was not significant.Conclusion: It seems that using of combination of a myelinating cells like OEC or schwann cell and source of cells to replace dead cells like Mesenchymal or embryonic stem cells, better results can be obtained due to probable synergic effects of these cells