The Challenges of Implementing the New Civil Liability System due to Violation of Competition Rules in the European Union

With the adoption of the EU Compensation Guidelines for the 2014 EU Anti-Monopoly Act to compensate for all damages and even profits and lost profits (direct and indirect purchasers), absolute liability was foreseen for violators of competition law. There are exceptions to this rule, of course. This did not happen until the end of 2016, despite the Member States' requirement to implement these rules in their national legal system due to legislative and administrative challenges. Some of the challenges are related to being possibility to turn us over to absolute responsibility or agree contrary to the rules of procedure, the deterrence aspect, litigation, challenges associated with indirect buyers at the end of the supply chain and informing buyers These challenges and other challenges that have arisen have led to the Union issuing a statement on how to implement the provisions of this directive in the legal system of the Member States. Identifying these challenges and the solutions offered in this regard can pave the way for legislative policy-making for the development and enhancement of competition law rules in the Iranian legal system

Effects of designed feeding patterns on fatigue in multiple sclerosis patients

زمینه و هدف: بیماری مولتیپل اسکلروزیس (MS) شایع ترین بیماری نورولوژیک در بالغین جوان است که آنها را ناتوان می سازد. خستگی یکی از شایع ترین علائم این بیماری است که نه تنها فعالیت و توانایی بیماران بلکه کیفیت زندگی آنها را نیز کاهش می‌دهد. تغذیه صحیح یکی از روش هایی است که می‌تواند برای کاهش خستگی مورد استفاده قرار گیرد. این مطالعه با هدف بررسی تأثیر الگوی تغذیه‌ای طراحی شده بر خستگی بیماران مولتیپل اسکلروزیس مراجعه کننده به انجمن MS ایران انجام شد. روش بررسی: در این مطالعه نیمه تجربی، 40 بیمار مبتلا به مولتیپل اسکلروزیس به روش نمونه گیری هدفمند و در دسترس انتخاب شدند. ابزار گردآوری داده ها، پرسشنامه محقق ساخته بود. آموزش رعایت الگوی غذایی به مدت 12 هفته بر روی بیماران انجام شد. پرسشنامه ها توسط بیماران قبل و بعد از مداخله تکمیل گردیدند. آنالیز داده ها با استفاده از شاخص های توصیفی (میانگین، انحراف معیار) و آمار استنباطی نظیرt زوجی، انجام شد. یافته ها: میانگین سنی نمونه های مورد مطالعه 5/1 ± 8/35 سال بود. میانگین شدت خستگی نمونه های مورد پژوهش قبل از مطالعه 77/0 ± 9/14 و بعد از رعایت الگوی غذایی 44/0 ± 6/25 بود که نشان می دهد شدت خستگی کاهش معنی داری داشته است (001/0>P). نتیجه گیری: الگوی غذایی ارائه شده در این مطالعه به عنوان یک روش ساده، ارزان، بدون عارضه و غیر تهاجمی برای کاهش خستگی بیماران مبتلا به مولتیپل اسکلروزیس موثر و قابل استفاده است

Relationship Between Practice and Attitude Regarding Pressure Injury Among Intensive Care Nurses in Iran: A Descriptive, Correlational Study

Purpose: A study was conducted to evaluate the relationship between critical care nurses' practice, demographics, and attitude regarding pressure injury. Methods: The descriptive-correlational study was conducted from March 14 to June 21, 2019, among nurses working in 3 intensive care units affiliated with Qazvin University of Medical Sciences in Iran. Using convenience sampling methods, nurses with at least a bachelor's degree in nursing who are involved in pressure injury care were invited to participate. Demographic information (age, sex, work experience in intensive care unit, education level) and pressure injury education information were collected from participants. Each nurse was observed 3 times by a researcher during his or her full work shift and evaluated using the Quality of Nursing Care Related to Pressure Injury checklist, which consists of 85 items categorized in 6 groups: 1) pressure injury risk factor evaluation (23 items), 2) change of patient position (12 items), 3) patient nutrition (16 items), 4) skin examination (25 items), 5) skin care in high-risk patients (5 items), and 6) use of accessories for pressure injury prevention (4 items). Each item offers 3 response options (ie, applied, not applied, applied but not correct). Correct responses on 70%, 69% to 50%, and less than 50% of items indicate good, relatively good, and poor practice, respectively. The Attitude Towards Pressure Ulcer Questionnaire, used to assess nurses' attitudes regarding pressure injury prevention, is a paper-and-pencil questionnaire that is completed by the nurse participants and consists of 11 items, with answers based on a 5- response Likert scale that ranges from 1 (totally agree) to 5 (totally disagree). The total score ranges from 11 to 55. A higher score indicates a more positive attitude. Descriptive statistics including mean and standard deviation were used to describe demographic information, and analytical tests including Pearson correlation test were used to determine the correlation between numerical variables. An independent t test was used to evaluate the differences in mean scores of numerical variables between the 2 groups. Significance level was considered as P < .05. Results: The mean quality-of-nursing checklist score was 71.4 ± 13.5, inferring nurses provided good care. The highest and lowest mean scores were related to skin examination (22.8 ± 3.7) and skin care in high-risk patients (4.3 ± 0.8). The mean overall score of nurses' attitudes toward pressure injury was 27.26 ± 5.1, indicating a positive attitude toward providing pressure injury care and prevention. There was a significant and positive relationship between mean years of practice and the mean attitude score (r = 0.195; P = .041) as well as a significant relationship between quality of practice and attitude score (r = 0.195; P = .041) Conclusion: Ninety percent (90%) of critical care nurses demonstrated a good practice and a relatively positive attitude toward pressure injury. Additionally, the findings suggest that nurses with more years of experience and a more positive attitude have better quality of practice. The results of the present study could be useful for improving pressure injury care in the hospital setting and for educating nurses and nursing students. Further research that includes nurses in other wards is warranted

Intensive care unit, cardiac care unit, and emergency department nurses' perceptions of medical device-related pressure injuries: a cross-sectional study

Background Nurses' perception of medical device-related pressure injuries (MDRPIs) may affect their performance, but there is a lack of studies in this area. Purpose The current study aimed to examine intensive care unit (ICU), cardiac care unit (CCU) and emergency department nurses' perception of proper prevention of MDRPIs and care for individuals with such injuries. Methods This descriptive study was conducted in 4 general hospitals in Iran in 2021. All nurses (N = 310) working in ICUs, CCUs and emergency departments of these facilities were invited to complete a researcher-made demographic checklist and an 11-item questionnaire to assess attitudes toward MDRPIs. The questionnaire item responses were scored from 1 (strongly agree) to 5 (strongly disagree) with the total score for the 11 items ranging from 11 to 55. A score of 11 to 25 was categorized as indicating a negative attitude toward proper prevention of MDRPIs and care for such patients; a score of 26 to 40 indicated a neutral attitude, and a score >40 indicated a positive attitude. Results A total of 260 nurses fulfilled the data collection tool. The response rate was 83.8%. The mean total score of attitude toward MDRPIs was 41.7. No significant relationship was observed between the total score of nurses' attitudes and their demographic variables. Of the 260 participants, 159 stated they had not received any trainings on MDRPIs at nursing schools during their education, 212 stated they had not participated in any scientific workshops on MDRPIs, and 167 described their knowledge about the prevention and care of MDRPIs as insufficient. Conclusion Among ICU, CCU, and emergency nurses in Iran, most had a positive attitude toward the prevention and care of MDRPIs, but steps should be taken to offer more opportunities for nurses to increase their knowledge in this area

The Evaluation of Social Medicine Training Programs from Point of View of General Practitioners

Background & Objective: Community oriented medical education has been considered by many universities. The aim of this study was to determine the general practitioners (GPs) point of view regarding social medicine training programs (SMTP). Methods: This cross-sectional study was conducted on GPs, graduated from different Iranian medical Universities after 1985, in Babol, Iran, in 2010. Subjects were selected by simple randomized sampling method. Data were gathered using a questionnaire consisting of three parts and analyzed using chi-square and Fisher’s exact tests by SPSS. Results: In this study 130 GPs, who had graduated 10.4 ± 5.7 years ago, were evaluated. Data showed some topics of SMTP, like occupational health, disease management, executing a research project, and presence in rural/urban health centers, were more common in GPs graduated after 2001 in comparisons with counterpart group. Moreover, GPs who worked in rural health centers indicated to have more attention on mental health, dental health, elderly care, disease management, and social health assessment methods in curriculum of SMTP. Conclusion: According to our findings, mental and occupational health along with elderly care should be considered in social medicine curriculum of medical students. Moreover, appropriate revisions on SMTP and continuous education programs on these topics for GPs are recommended. Keywords Education Medical students Social medicine training progra

Effect of Aloe vera Gel, Calendula officinalis Ointment and Simple Prophylactic Sacral Dressings for Pressure Injury Development

Background and Purpose: Prophylactic dressings play a significant role in the prevention of pressure injury. However, no herbal products have been used in this regard, so far. Therefore, the present study was designed with the aim of comparing the effect of Aloe vera gel, Calendula officinalis ointment and simple sacral prophylactic dressings on pressure injury development in patients admitted to intensive care unit. Materials and Methods: The sample of this clinical trial study consisted of 90 critically ill patients. Randomization was performed by head nurse in intensive care unit. Patients in group “A” received Aloe vera gel prophylactic dressing twice a day; patients in group “B” received Calendula officinalis ointment prophylactic dressing twice a day; and patients in group “C” received simple prophylactic dressing twice a day. The development of pressure injury was compared between these three groups after the intervention. Results: Demographic variables were similar in all three groups (p> 0.05). The results showed that 3 patients (10%) who received the simple dressing, 2 patients (6.6%) who received the Calendula officinalis ointment dressing were wounded, while the development of pressure injury in patients who received the Aloe vera gel dressing was zero. The results of chi-square test showed that the frequency distribution of the pressure injury development in the two groups receiving Aloe vera gel and simple dressing was different. This difference was statistically significant (p < 0.05). However, there was no significant difference between the Aloe vera gel and Calendula officinalis ointment groups as well as the Calendula officinalis ointment group and the simple dressing. Conclusion: The results of the present study demonstrated that using Aloe vera gel and Calendula officinalis ointment prophylactic dressing twice a day can be effective in prevention of pressure injury in patients admitted to intensive care unit. Keywords: Aloe vera gel, Calendula officinalis ointment, critically ill patient, medicinal plants, prophylactic dressing

Quality of life of family caregivers of patients with a stoma: A cross sectional study from Iran

Aim: The family plays a key role in supporting and caring for patients who have a gastrointestinal stoma because of cancer. This study investigated the quality of life of family members caring for such patients. Methods: A descriptive study was conducted in 2020 in Iran. The study sample consisted of 250 family members caring for cancer patients with an intestinal stoma. The Caregiver Quality of Life Index–Cancer scale was used to measure quality of life. This scale has 35 questions, which are categorised into four subscales: mental/emotional burden; lifestyle disruption; positive adaptation; and financial concerns. The highest possible total score is 140 (35 in each subscale), and a high score indicates a poor quality of life. Results: A total of 250 carers took part in the study. Of these, 143 (57.2%) were men and the average age was 35.1 years. Mean scores of mental/emotional burden, lifestyle disruption, positive adaptation, and financial concerns were 28.4±41, 17.3±3.2, 19.8±28, and 8.6±1.2 respectively. No significant relationship was found between participants' quality of life and demographic variables. Conclusion: Carers' quality of life is relatively poor. Carers' quality of life need to be improved and support programmes, devised and delivered by nurses, could have a role in thi

Incidence and risk factors for medical device-related pressure ulcers: The first report in this regard in Iran

Few studies, especially among developing countries such as Iran, have been conducted on the incidence and risk factors for medical device-related pressure ulcers (MDRPUs). Given the importance of this issue and the lack of previous studies, the present study aimed to investigate the incidence and risk factors for MDRPUs in Iran. The present descriptive-analytical study was conducted at three hospitals in Qazvin, Iran, from June 1, 2019, to September 1, 2019. Data collection took approximately 3 months from July to September 2019. Sampling was carried out through a convenience sampling method, and the samples consisted of 404 patients. For data collection, a checklist for demographic variables, a checklist for patient-connected medical devices, Braden Scale, Glasgow Coma Scale, National Pressure Ulcer Advisory Panel Pressure Grading Scale, and Nutrition Risk Screening 2002 were used. Of the 404 patients studied, 20.54% (n = 83) developed some degree of MDRPUs. From those, 61 (70.11%) were in stage I, 17 (19.5%) were in stage II, and 9 (10.34%) were in stage III. Among the nine medical devices that caused pressure ulcers, the most commonly reported ones were nasal oxygen tubes (31 cases), oxygen face masks (23 cases), and endotracheal tubes (17 cases). The mean score of Braden Scale (P = .004), the mean score of NRS 2002 (P = .037), older age (P = .007), male gender (P = .002), the average length of stay in hospitals (P = .001), and having pressure ulcers in body (P = .025) significantly increased the possibility of occurring MDRPUs. In the present study, the incidence of MDRPUs was high. Taking the necessary measures into consideration in order to prevent the MDRPUs is essential in Iranian hospitals. Further studies in this regard are strongly recommended

Hopelessness, Perceived Social Support and their Relationship in Iranian Patients with Cancer

Objective: Cancer is considered a global health problem and its prevalence has been growing in recent years. The present study was conducted to investigate the role of hopelessness and perceived social support for Iranian patients with cancer. Methods: Convenience sampling was used to select the study sample comprising 100 patients with cancer presenting to the Education and Treatment Center of Valiasr in Zanjan, Iran. A demographic questionnaire, the Beck Hopelessness Scale, and the Social Support from Family and Friends Scale were used to collect the data. Collected data were analyzed using SPSS-16. Results: Of the 98 study patients, 52 (53.1%) were female and the remainder were male. Lung cancer constituted the most prevalent type of cancer (25.5%). The mean hopelessness score was 5.93 ± 4.71. The mean scores for social support provided by family and friends were 10.89 ± 5.61 and 14.94 ± 4.16, respectively. Significantly negative correlations were observed between the mean scores of hopelessness and social support provided by family (P = 0.007; r = −0.270) and friends (P = 0.001; r = −0.327). Conclusion: According to the findings of the present study, Iranian patients with cancer have relatively mild levels of hopelessness and moderate levels of social support. Perceived social support was also found to affect the patients' hopefulness. Given the lack of studies on this subject, it is recommended that further studies are performed