A randomized controlled multimodal behavioral intervention trial for improving antiepileptic drug adherence

Purpose: Medication nonadherence is one of the most important reasons for treatment failure in patients with epilepsy. The present study investigated the effectiveness of a multicomponent intervention to improve adherence to antiepileptic drug (AED) medication in patients with epilepsy. Methods: In a prospective, randomizedmulticenter trial, three sessions of face-to-facemotivational interviewing (MI) in combination with complementary behavior change techniques were compared with standard care.Motivational interviewing prompted change talk and self-motivated statements from the patients, planning their own medication intake regimen and also identifying and overcoming barriers thatmay prevent adherence. Participants were provided with calendars to self-monitor their medication taking behavior. A family member and the health-care teamwere invited to attend the last session ofMI in order to improve the collaboration and communication between patients, their caregiver or family member, and their health-care provider. At baseline and 6-month follow-up, psychosocial variables and medical adherence were assessed. Results: In total, 275 participantswere included in the study. Comparedwith the active control group, patients in the intervention group reported significantly highermedication adherence, aswell as stronger intention and perceptions of control for taking medication regularly. The intervention group also reported higher levels of action planning, coping planning, self-monitoring, and lower medication concerns. Conclusions: This study shows that MI can be effective in clinical practice to improvemedication adherence in patientswith epilepsy. It also provides evidence that combining volitional interventions, including action planning, coping planning, and self-monitoring withmotivational interviewing can promote the effectiveness of the medical treatments for epilepsy by improving adherenc

Explanation of Loneliness in the Elderly and Comparison With Psychosocial Development Theory: A Quantitative Study

Introduction: Loneliness is universal, still very subjective feeling, natural to all human beings and a subjective experience of isolation. Many people may be ashamed of talking about it or admitting they feel lonely, because they are afraid of being stigmatized. The purpose of this study was to explore elderly experiences of loneliness and comparison with the Erikson’s theory. Materials and Methods: this study was a qualitative research with content analysis approach. The research population was twelve elderly, aged 68-85 years who lived in Hamadan city. Sampling began purposefully and continued until data saturation. To collect data, interview was used. All interviews were tape recorded and transcribed immediately. Data was analyzed using content analysis method. Results: In total, 187 primary codes, 7 subcategories and 3 main categories were obtained in which, the 3 main categories were feelings of alienation, separation of favorite activities, and fatigue and sadness. Core category or shared meaning was regret with heavy. Conclusion: Loneliness is common in elderly and associated with adverse health consequences both from a mental and physical health points of view. Therefore, appropriate intervention strategies to reduce isolation using the Erikson’s psychosocial theory can improve elderly quality of life to achieve Ego integrity throughout the life

Crude and standardized prevalences of cataract and related factors in the elderly people in Northern Iran

Purpose: This study aims to estimate the crude and standardized prevalences of cataract and its related factors among old people in northern parts of Iran. Methods: This cross-sectional study was carried out among 397 people aged 60 and older in northern Iran. Required information about treated and nontreated cataract was collected using a standard checklist. The World Standard Population was applied for direct standardization. Results: The standardized prevalence (95% confidence interval) of cataract among men, women, and all people were 27.5% (21.2–33.8), 30.9% (24.5–37.4), and 29.1% (24.6–33.6), respectively. Based on multivariate logistic regression models, age over 75 years (OR = 3.03, 95% CI: 1.21–7.59), living alone (OR = 4.89, 95% CI: 1.86‒12.86), diabetes mellitus (odds ratio = 19.10, 95% confidence interval: 8.13–44.89), rheumatoid arthritis (OR = 7.76, 95% CI: 2.32–25.99), history of infectious diseases (OR = 4.02, 95% CI: 1.35‒11.98), hypertension (OR = 3.19, 95% CI: 1.59–6.42), history of ophthalmic surgery (OR = 2.83, 95% CI: 1.29–6.16), history of sedative drug use (OR = 2.71, 95% CI: 1.35–5.47), history of vitamin supplementation use (OR = 0.21, 95% CI: 0.08–0.55), and familial history of cataract (OR = 2.81, 95% confidence interval: 1.38–5.72) increased the odds of cataract. Our multiple logistic regression model explained 53% of the variation in developing cataract. Conclusion: Our study showed that the prevalence of cataract in the study population was relatively high. We also found that aging, living alone, diabetes mellitus, rheumatoid arthritis, hypertension, infectious diseases, ophthalmic surgery, sedative drugs and familial history of cataract were the risk factors of cataract and vitamin supplementations were its protective factors

Concept analysis of competency in nursing: Qualitative research

(Received 23 Sep ,2008; Accepted 3 Dec ,2008) AbstractBackground and Purpose: Competency is a complicated and an ambiguous concept. It is also a challenging subject in the health care arena, which is significant in different aspects of nursing, such as education, clinic and management. There are ambiguities about it, thus, in this article, researchers conducted analysis of this concept. Materials and methods: This research is a concept analysis by the hybrid method. This model has three steps. In literature review stage, 475 related articles exist in databases up to September 2007 were analyzed and evaluated. As to the importance of educational system in the training of nursing courses, 5 educators were interviewed in the field work stage. After listening to tapes, results were Tran scripted and content analysis was done. In the last stage, holistic analysis was carried out.Results: Best definition and properties of competency was selected based on literature reviews. In the field work stage, categories and attributes, same as literature reviews stage, were emerged with interviewing of nursing educators, in addition to holistic view properties, in relation to attitude domain and creativity of management domain. In the last stage, a hybrid model was delivered.Conclusion: In the Iranian field of nursing, educational planning, implementing competency instrument, nurses and students evaluation can be performed according to this study criterion. J Mazand Univ Med Sci 2008; 18(67):35-42 (Persian

Effect of home-based exercise on functional ability of hemodialysis patients: a systematic review and meta-analysis

Background: hemodialysis patients suffer from impaired functional ability. Several pilot studies have been conducted concerning the effect of home-based exercise on functional ability of hemodialysis patients; however, there have been observed some contradictions between the results of these studies. The aim of this study was, therefore, to determine the effects of home-based exercise on functional ability of hemodialysis patients using meta-analysis. Methods: In this review study, for the purpose of finding studies published electronically form 2000 to 2016, the papers published in journals indexed in the databases of “PubMed, Science Direct, Google Scholar Cochrane” were used. Also, to analyze the full text of these articles, Stata Software Version 11 was used. Heterogeneity index between the studies was determined using Cochran (Q) c and I2 tests. Since heterogeneity was observed between the studies, a random effect model was used to estimate the mean score of the standardized difference of a 6-minute walk test in order to measure the functional ability of hemodialysis patients in two experimental and comparison groups. Results: Four articles were finally selected in this meta-analysis. 68 patients were in the experimental group and 65 were in the control group. After the intervention, the mean score of the standardized difference of a 6-minute walk test in the experimental group with a confidence interval of 95% was 0.21 (-0.15, 0.57) units more than before the intervention, which was statistically not significant. Conclusion: The results of the meta-analysis showed that home-based exercise increased the functional ability of hemodialysis patients although this effect was not significant

Effect of home-based exercise on functional ability of hemodialysis patients: a systematic review and meta-analysis

Background: hemodialysis patients suffer from impaired functional ability. Several pilot studies have been conducted concerning the effect of home-based exercise on functional ability of hemodialysis patients; however, there have been observed some contradictions between the results of these studies. The aim of this study was, therefore, to determine the effects of home-based exercise on functional ability of hemodialysis patients using meta-analysis. Methods: In this review study, for the purpose of finding studies published electronically form 2000 to 2016, the papers published in journals indexed in the databases of “PubMed, Science Direct, Google Scholar Cochrane” were used. Also, to analyze the full text of these articles, Stata Software Version 11 was used. Heterogeneity index between the studies was determined using Cochran (Q) c and I2 tests. Since heterogeneity was observed between the studies, a random effect model was used to estimate the mean score of the standardized difference of a 6-minute walk test in order to measure the functional ability of hemodialysis patients in two experimental and comparison groups. Results: Four articles were finally selected in this meta-analysis. 68 patients were in the experimental group and 65 were in the control group. After the intervention, the mean score of the standardized difference of a 6-minute walk test in the experimental group with a confidence interval of 95% was 0.21 (-0.15, 0.57) units more than before the intervention, which was statistically not significant. Conclusion: The results of the meta-analysis showed that home-based exercise increased the functional ability of hemodialysis patients although this effect was not significant

Effects of Early Family-centered Sensory Stimulation on Disability and Rehabilitation of Stroke Patients

Background and purpose: Stroke is the most common and debilitating neurologic lesion in adults. Early family-centered stimulation have positive outcomes in stroke patients. The present study was designed to investigate the effect of early family-centered sensory stimulation on restoring function and recognition in stroke patients. Materials and methods: A clinical trial was done in 60 patients with impaired consciousness due to stroke (GCS=5-10) admitted in intensive care unit (ICU). The participants were assigned into control and experimental groups (n=30 per group) using randomized block design. The experimental group received sensory stimulations of the five senses in the first 48-72 hours after the stroke by family members for 14 days. The control group received ICU routine care. At days 5, 10, and 15, the consciousness level was assessed by GCS and FOUR and cognitive function was assessed by Disability Rating Scale. Results: Sensory stimulations significantly increased the mean score for cognitive function in the experimental group compared to the control group (P<0.001). The effect sizes of cognitive function at days 5, 10 and 15 were 0.45, 0.95, and 1.09, respectively. The effect sizes were small at day 5 and large at days 10 and 15. No significant differences were observed in the level of consciousness (P=0.601) and function (P=0.710). Conclusion: In current study, early family-centered sensory stimulation in patients with impaired consciousness due to stroke improved their cognitive function but did not significantly influence their disability score.   (Clinical Trials Registry Number: IRCT20151004024342N6

The psychometric assessment of the chronic disease self-efficacy scale in iranian patients with chronic diseases

Background: To provide better health care to chronic patients, the use of valid and reliable tools is necessary. This study aimed to assess the psychometric properties of the Persian version of the Chronic Disease Self-Efficacy Scale (CDSES). Methods: In the objective of the present methodological study 401 patients with chronic disease including renal and cardiac disease, diabetes and hypertension were selected by convenience sampling from three hospitals in Mazandaran province in Iran and filled out the CDSES. The 33-item CDSES has three dimensions. The face, content, construct, convergent and discriminant validities of the scale were assessed. Reliability was determined by internal consistency and construct reliability. Results: Based on exploratory factor analysis, a five-factor solution was selected, explaining 55.03% of the total variance. By confirmatory factor analysis, the five-factor solution and the second-order latent factor model were supported. The convergent and discriminant validities of all the factors were acceptable. The reliability of CDSES exceeded α>0.7. Conclusion: The present study results showed that the five-factor construct of CDSES had a suitable validity and reliability; thus, the Persian version of this scale can be used in assessing self-efficacy in chronic patient

The Relationship between Sleep Quality with Depression in Patient with Acute Myocardial Infarction

Background and Objectives: Depression is one of the most psychological outcomes in patients with acute myocardial infraction, which can affect the sleep quality in these patients. Given that adequate sleep has important effect on heart function, the present study was conducted with the aim of determining the correlation between sleep quality with death and cardiac depression in patient with acute myocardial infarction (AMI). &nbsp; Methods: In this descriptive-correlational study, 407 patients with acute myocardial infarction, who were admitted to the CCU wards of the Fatemeh Zahra Educational Center of Sari city, were selected using simple random sampling method. Data were collected by Cardiac Depression Scale (CDS), Death Depression Scale (DDS), and Pittsburgh Sleep Quality Index (PSQI) questionnaires. Data were analyzed using Kolmogorov-Smirnov and Pearson correlation tests. &nbsp; Results: The mean age of the male patients (64.95&plusmn;17.00; CI95: 62.71-67.19) was more than the mean age of women (62.22&plusmn;15.48; CI95: 59.96-64.48). The mean score of death depression (68.94&plusmn;17.24; CI95: 67.26-70.62) and cardiac depression (109.00&plusmn;16.49; CI95: 107.39-110.60), were below the fifth percentile. Multivariate regression analysis showed that change in cardiac depression score (B=0.036, &beta;=0.153), increasing education levels (B=1.55, &beta;=-0.121), and no history of antidepressant usage (B=4.32, &beta;=0.123), can be significantly independent predictive factors of the variance of sleep quality score in acute myocardial infarction patients. &nbsp; Conclusion: According to the results of this study, although cardiac depression, education level, and non-use of antidepressant drugs are considered as affecting factors in the prediction of sleep quality in acute myocardial infarction patients, sleep quality is affected by more factors. Therefore, further studies are needed in this area. &nbsp; &nbsp

Study of some risk factors and accelerating factors of heart attack and the delay reasons in referring to theMazandaran Cardiac Center in 2009

12 3 4 (Received 21 October, 2009 ; Accepted 13 January, 2010)AbstractBackground and purpose: Coronary artery disease (CAD) particularly of the acute myocardial infraction (MI) is one of the main causes of mortality in the developing countries. Considering the complication of the disease, the aim of this study was to investigate risk and accelerating factors of heart attack and the reason of the patients' delay in referring to Mazandaran Cardiac Center in 2009.Materials and methods: This cross-sectional study was preformed on 200 acute myocardial infarction (AMI) patients. The criteria of diagnosis for AMI in this study was ST elevation of ECG, increase of CKMB above 25 in three phases and increase of Troponin-1 above 1nd/ml and also LDH increase: The demographic information, history of having specific and related disease and the heart attack accelerating factors and the reason of delay in referring to cardiac center was recorded in questionnaire. The collected data were coded, then analyzed by X2 test and ANOVA test using u. SPSS soft wave.Results: Of 200 patients under study, 57% were male. With mean age and BMI of 62.02 years and of 26.66 respectively. The major risk factor in incidence of heart attack in this study first was high blood pressure (24.7 %) and the second one was diabetes mellitus 15.5 %. The accelerating factors of heart attack were heavy physical activity (25.3 %), sudden wake ups (25.2 %), and mental work along with tension (12.6 %) respectively.Conclusion: Considering the risk factors and heart attack accelerating factors, providing proper education to the public, it is possible it reduce the number of heart attack cases and implement proper strategy to reduce the delay in referring of such patients to a cardiac center. J Mazand Univ Med Sci 2009; 19(73): 69-74 (Persian)