Oral metronidazole as antibiotic prophylaxis for patients with nonperforated appendicitis

Hassan Ravari1, Ali Jangjoo2, Jalal Motamedifar2, Kasra Moazzami31Vascular and Endovascular Surgery Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, 2Department of General Surgery, Mashhad University of Medical Sciences, Imam Reza Hospital, Mashhad, 3Department of General Surgery, Tehran University of Medical Sciences, Sina Hospital, Tehran, IranBackground: The rate of wound infection after appendectomy without antibiotic prophylaxis is 10%–30%. The role of prophylactic antibiotic therapy in nonperforated appendicitis is still controversial. Metronidazole is against anaerobic organisms and its bioavailability after oral and parenteral administration has been shown to be similar. The objective of the present study is to compare the infective complications rate after open appendectomy for nonperforated appendicitis receiving either oral or intravenous metronidazole as prophylaxis. Methods and Materials: From June 2007 to July 2009 in a randomized controlled trial, 204 patients with nonperforated appendicitis underwent an open appendectomy; 122 male and 82 female with mean age of 25 years. Among these, 102 (case group) received oral metronidazole and in 102 (control group) metronidazole was administered intravenously before surgery. The rate of wound infection and duration of the postoperative hospital stay was studied in the two groups.Results: The rate of wound infection was not significantly different in the two groups. (6% and 4% in study and control group, respectively, P = 0.861). Also the hospital stay was equal in two groups (2.3 days and 2.7 days in study and control group, respectively, P = 0.293).Conclusion: Single dose of oral metronidazole prior to operation can provide a sufficient prophylaxis for nonperforated appendicitis; so, it can be substitute the parental route of antibiotic administration. Keywords: antibiotic prophylaxis, wound infection, appendectomy, complication

Association of interleukin-4 polymorphisms with multiple sclerosis in southeastern Iranian patients

BACKGROUND AND OBJECTIVES: Immune system related factors are important in the pathogenesis of multiple sclerosis (MS). Interleukin 4 (IL-4) as a helper T cell (2TH) cytokine is involved in the regulation of immune responses. Hence, this study was designed to explore the association between MS and polymorphisms in the -590 region of IL-4. DESIGN AND SETTING: A descriptive study at Rafsanjan University of Medical Sciences, Rafsnajan from September 2009 to August 2010. PATIENTS AND METHODS: Blood samples were collected from 100 MS patients and 150 healthy controls on EDTA precoated tubes. DNA was extracted and analyzed for IL-4 polymorphisms using restricted fragment length polymorphism in patients and controls. Demographic data were also collected by a questionnaire that was designed specifically for this study. RESULTS: We observed a significant difference in the C/C, T/C, and T/T genotypes of the -590 region of IL-4 between patients with MS and healthy controls (P <.001). CONCLUSIONS: We conclude that functional polymorphisms of IL-4 possibly play a crucial role in the pathogenesis of MS

HIV/AIDS Patients’ Experiences about Stigma: a Qualitative Study

Introduction: HIV/AIDS stigma has influenced HIV/AIDS patients and the medical system. The purpose of this study was to explore the experience of perceived stigma in these patients in relation to the public and health care workers (PLWHA). Method: In-depth, semi-structured interviews were held with a purposively selected group of 61 PLWH recruited from two HIV care clinics in Tehran during 2009-2010. Data were analyzed using the content analysis approach. Results: The results were categorized into two themes based on the two major themes of extrinsic stigma (i.e. taunting, bashfulness and discrimination) and intrinsic stigma (i.e. rejection, seclusion, and frustration). Conclusion: Taunting and rejection were among the patients' main experiences. This study implies that it is crucial to integrate education to reduce stigma into HIV education programs by behavior change theories. Keywords: HIV/AIDS, Stigma, Qualitative study, Patients

Standard Precautions: Compliance to Precautions or Precautions as a Barrier: A Qualitative Study

Introduction: Despite the presence of standard precautions and the necessary education provided to the staffs about compliance to precautions, their performance has continuously been accompanied with some problems. The present research is conducted to explain nurses’ experiences of the hindering factors of commitment to precaution standards in nurses working in hospitals. Method: This research was conducted with a qualitative approach through the content analysis method. The data were collected using 15 face-to-face interviews and 5 sessions of focus group. On average, 5 nurses and nursing assistants participated in each session. The overall number of participants was 40. All interviews were recorded, transcribed verbatim, and analyzed using the content analysis method. Here, MAXQDA 10 software was used for data management. Results: Based on experiences of the participants, 3 main themes emerged: hardware carelessness, perceptive carelessness, and compulsory carelessness. Lack of needed equipment in the unit, and lack of access to and low quality of the equipment were among the factors leading to hardware carelessness. Not believing in infection transmission, lack of fear of potential dangers, damage induced by performing the standards, being ridiculed by other staff, and negative effects induced by performing the standard precautions on patients and their companions result in perceptive carelessness. Finally, work overload, unpredicted situations, and emergency conditions are among the factors effective on compulsory carelessness. Conclusion: The findings of this study revealed that some participants did not believe in compliance to standard precautions. They not only assumed their compliance as not useful, but also considered it as detrimental. Hence, for compliance to standard precautions, only emphasizing on educating the staff and offering the procedures does not suffice. Rather, it is required to reinforce commitment to these precautions through changing staff’s outlook as well as supplying the needed equipment and instruments. Moreover, creating conditions under which the staff can comply with these precautions is necessary. Keywords: Standard precaution, Compliance, Qualitative research

Prioritizing the Effective Components on Motivation of Employee Staff in Rafsanjan University of Medical Sciences using TOPSIS Technique

Background: Motivation is an intrusive force that leads individuals physiologically and psychologically to pursue their goals to meet their needs and expectations. Considering the importance of motivation in the health sector, this study aimed to prioritize the effective factors on staff motivation in Rafsanjan University of Medical Sciences. Methods: This is a descriptive-analytic study that was conducted in a cross-sectional fashion in 2016 on 222 staff members of Rafsanjan University of Medical Sciences who were selected by stratified random sampling method. A researcher-made questionnaire comprised of 40 questions in 11 dimensions including salary, policy, occupational safety, environmental conditions, supervision and support, appreciation, job development, the nature of work, job responsibility, occupation, and communication was used to collect data. The TOPSIS and SPSS 21 software were used to analysze data. Results: There was a significant relation between education level and motivation, but there were no significant relations between age, employment status, and career path and motivation. Also, the results of ranking the options indicated that the communication option with (0.74%) had the highest priority and the appreciation option with (0.29%) had the least priority in motivational factors. Conclusion: Since communication in this study was the most important among the motivational factors of the employee staff, it is suggested that managers develop a sense of trust and friendship between management and employees through facilitating and expanding vertical communication in order to increase motivation among employee staff. Keywords: Motivation, Employee Staff, Medical University, Prioritize, TOPSIS techniqu

Quality Assessment of Educational Services for Residents in Teaching Hospitals of Kerman University of Medical Sciences, Iran, based on the SERVQUAL Model

Background & Objective: Quality assessment of educational services is one of the most important actions in line with an improvement in the services. If the qualitative dimension of services is not taken into account, we will observe significant academic failure and reduction in creativity among the learners. Therefore, one of the salient steps in improving the quality of educational services is quality assessment from the viewpoints of its users. The aim of the present study was to determine the quality of educational services from the viewpoints of residents based on the SERVQUAL model. Methods: In this descriptive-analytical study, 204 residents from the educational hospitals of Kerman, Iran, participated. The participants were selected using simple random sampling method. The data collection tool was the Evaluation of Educational Quality Questionnaire that evaluates educational quality based on the SERVQUAL gap analysis method. This tool compares respondents’ perceptions and expectations of the quality of educational services in 5 domains (reliability, responsibility, confidence, assurance, empathy, and tangible physical). Content validity of this questionnaire was approved by experts' opinions and its reliability was confirmed using Cronbach's alpha (r = 0.88). To analyze data, SPSS software was used for performing descriptive (mean, standard deviation) and analytical (independent t-test) tests. Results: The findings showed that there was a negative gap between residents' perceptions and expectations of the quality of educational services in all 5 dimensions. The highest and lowest level of gap was related to the tangible physical (-1.50) dimension and the responsibility (-0.51) dimension, respectively. Conclusion: There is a negative gap between residents' perceptions and expectations in different dimensions of educational services quality based on the SERVQUAL model. In order to improve the quality of education, a review of educational infrastructures (environment and facilities) and education management seems necessary. This requires the efforts of relevant authorities toward the development and improvement of these infrastructures. Keywords: Evaluation; Quality; Residents; Educational services; SERVQUAL mode

The Impact of Spiritual Care Education on the Self-Efficacy of the Family Caregivers of Elderly People with Alzheimer’s Disease

Background: Caring for people who suffer from Alzheimer’s disease is stressful. Family caregivers of these people usually experience physical and mental burnout and lose their efficacy in doing care-related activities. The present study aimed to examine the impacts of spiritual care education on self-efficacy of the family caregivers of people with Alzheimer’s disease. Methods: This study was conducted from October to December 2015 by using a two-group pretest-posttest quasi-experimental design. In total, 60 family caregivers of people with Alzheimer’s disease were recruited and randomly allocated to the intervention and control groups. A spiritual care educational intervention was implemented for the caregivers in the intervention group. The data were collected before and three weeks after the study intervention by using the ten-item General Self Efficacy scale. The study data were analyzed in SPSS using Chi-square and independent t-test. Results: Before the study intervention, the means of pretest self-efficacy scores in the intervention and control groups were 29.80±4.80 and 28.39±6.41, respectively. There was no significant difference between the groups regarding the mean score of self-efficacy (P=0.36). After the study, these two scores changed to 32.73±4.75 and 27.85±5.98, respectively. However, after the intervention, the mean score of self-efficacy in the intervention group was significantly higher than the control group (P=0.002). Conclusion: Spiritual care can enhance the self-efficacy of the family caregivers of people who suffer from Alzheimer’s disease. Therefore, care providers are recommended to use such spirituality-based interventions for empowering family caregivers

Effect of Head and Face Massage on Agitation in Elderly Alzheimer's Disease Patients

Background: Management of agitation in Alzheimer's patients with non-invasive treatment methods, such as massage therapy, is of paramount importance. Aim: This study was conducted to determine the effects of head and face massage on agitation in elderly Alzheimer’s patients living in nursing homes in Yazd, Iran. Method: This randomized controlled clinical trial was conducted on two groups (n=35 in each group) from 26 September to 5 October 2016. For the patients in the intervention group, massage therapy was performed using the effleurage and compression techniques, and no intervention was implemented in the control group. The usual way to control the symptoms of agitation was physical restraint. The Cohen-Mansfield Agitation Inventory (CMAI) was used to measure the agitation level. The data were analyzed by performing Wilcoxon and Mann-Whitney tests in SPSS, version 18. Results: The mean ages of the intervention and control groups were 82.2±10.6 and 81.5±9.6 years, respectively. The mean scores of agitation in the intervention and control groups decreased from 77.2±14.4 and 82.1±17.3 before the intervention to 49.7±6.0 and 80.8±18.3 after the intervention, respectively. The results showed a significant difference between the two groups after the intervention (

The Effect of Yoga on Musculoskeletal Pain in Elderly Females: A Clinical Trial

Objectives: Chronic musculoskeletal pain is a common problem in the elderly. Yoga exercise can be considered a non-pharmacological and complementary method for pain control. The present study was conducted to investigate the effect of yoga on chronic musculoskeletal pain in elderly females referring to selected health centers in Rafsanjan, Iran. Methods: In this clinical trial, 60 females over 60 years of age with musculoskeletal pain were randomly divided into two intervention and control groups. The intervention group received three one-hour training sessions weekly for eight weeks, and they did yoga for 1 hour in each session. The pain was measured in both groups before the intervention and at weeks four and eight using the McGill Pain Questionnaire. The control group did not receive any special intervention. Results: The mean musculoskeletal pain decreased at the end of the 4th and 8th weeks after performing yoga in the intervention group compared to the control group (P0.005). However, at the end of the eighth week, all the pain subscales decreased in the intervention group (P<0.005). Discussion: The obtained results revealed that practicing yoga continuously could reduce musculoskeletal pain in elderly females; thus, it is suggested that such yoga exercises be included in the treatment of musculoskeletal pain in this group

The relationship between health literacy and quality of life in retirement of Rafsanjan University of Medical Sciences

Background and objective: Health literacy of individuals have the capacity to obtain, process and understand basic information to decide an appropriate health service in this area is necessary. This study aimed to determine the association between health literacy and quality of life in retirement Rafsanjan University of Medical Sciences. Methods: This cross-sectional study on 137 retirees of the city of Rafsanjan University of Medical Sciences. The sampling method was census. The validity of the questionnaire Functional Health Literacy Adult TOFHLA, and the questionnaire was 36 SF. Information collected through SPSS18 software and using ANOVA statistical tests, and chi-square and Pearson correlation and regression analysis. Results: Total score quality of life and level of health literacy in retirement for the 58.9047 and 57 .07&plusmn; 60.45 respectively. Health literacy as a predictor of quality of life score (001 / = 0p and 064 / 0r =). One-way analysis of variance between health literacy and age, and chi-square test showed that the variables life style, education, efficient your knowledge, has a significant relationship with the disease. However, health literacy level variables marital status, sex, satisfaction with the economic situation, and the drug had no significant relationship. Conclusion: Retirement planning in order to increase the level of health literacy can enhance their quality of life Keywords: seniors, health literacy, and quality of life. Paper Type: Research Article