Demographic and Technical Risk Factors of 30-Day Stroke, Myocardial Infarction, and/or Death in Standard- and High-Risk Patients Who Underwent Carotid Angioplasty and Stenting

Background: Carotid angioplasty and stenting (CAS) is an accepted treatment to prevent stroke in patients with carotid artery stenosis. The purpose of this study is to identify risk factors for major complications after CAS. Materials and Methods: This is a prospective study that was conducted at Shiraz University of Medical Sciences in southern Iran from March 2011 to June 2014. Consecutive patients undergoing CAS were enrolled. Both standard- and high-risk patients for endarterectomy were enrolled. Demographic data, athero- Published online: June 9, 2015 Afshin Borhani Haghighi, MD Department of Neurology Nemazee Hospital Shiraz 71345 (Iran) E-Mail neuro.ab @ gmail.com www.karger.com/ine DOI: 10.1159/000430923 This work was done as the thesis project for the medical degree by Ms. Samaneh Yousefi

The Effect of Bubble making on the Procedural Pain of Injection in Thalasemic School- aged Children in Kerman Thalasemia Center

Introduction: Medical procedures are common sources of pain for children. Children with chronic illnesses experience an even greater number of painful procedures as part of their condition diagnosis, treatment, and monitoring. Several methods are reported for reducing the pain. Clinicians commonly used distraction methods for decreasing pain. However there is no consensus among them about what distraction method is better for reducing injection pain. Objective: This study carried out to assess the Effect of Bubble making on The Procedural Pain of Injection in Thalassemic School- aged Children in Kerman Thalasemia Center Method: The present study is a clinical trial. The research sample consists of 40 thalassemic children with 6-12 years old, who have registered in Kerman thalasemia center. The participants were randomly divided into two groups (control and experimental). In the experimental group, bubble making was performed. The data gathering instruments were included: demographic information questionnaire, the investigation scale of pain behavioral signs, numeric pain scale. The analysis of the data was carried out through descriptive and analytical statistics. Results: The data indicated that there was a significant difference between the average scores of pain in the two groups after injection (P<0.05) Conclusion: Based on the result of this study, the distraction (Bubble Making) can reduce the pain of injection procedures in children. Keywords: Pain, Bubble making, Distraction, School- aged Children, Thalasemi

The Severity of Pain in Children with Thalassemia during Venipuncture and Prior to Blood Transfusion

Background: One of the most common invasive procedures in children especially children with thalassemia, which have to receive blood transfusions continuously to stay alive, is establishing an intravenous line. Recognizing and evaluating pain is one of the main responsibilities of nurses and the medical staff. The present study was conducted in order to assess the behavioral pain symptoms induced in 3-6 year old children with thalassemia during venipuncture for blood transfusion. Methods: The present research was a descriptive and analytical cross-sectional study on 120 children between 3 to 6 years of age, who were referred to Kerman Thalassemia Center and matched the inclusion criteria. Data were collected using a demographic questionnaire and a scale for pediatric behavioral pain symptoms. Data were analyzed using descriptive (percent, mean and standard deviation) and analytical statistics (Spearman correlation, Mann-Whitney U). Results: In this study 50.8% of subjects were female and 49.2% were male. The mean age of the children was 4.1 ± 1.1, 18.3% reported that they had mild pain, 32.5% indicated moderate pain and 49.2% had severe pain. The mean behavioral pain symptoms score of the children was 6.8 ± 2.4. Girls and younger children reported a significantly higher rate of pain. Conclusion: Considering the key role of nurses in health services, we hope that the results of this study will help them consider reducing pain of thalassemia children during venipuncture and this will decrease undesirable mental, emotional and physical complications of these children, who undergo painful procedures. Keywords: Pain, Thalassemia, Venipuncture, Nurs

The effect of distraction by bubble-making on the procedural anxiety of injection in Thalassemic school- age children in Kerman Thalasemia center

Background and aim: Medical procedures, particularly injection, cause anxiety in children. Copingwith invasive medical treatment is an important issue for all children, particularly chronically illchildren such as thalassemic children who may have to endure many treatment procedures. Thisstudy examined the effect of breathing exersice on the anxiety resulted from the injection procedurein thalassemic school-age children in Kerman thalassemia centerMaterials and Methods: In this clinical trial, 40 thalassemia children with 6-12 years old, inKerman thalasemia center were selected through convenience sampling method. Then subjects wererandomly allocated in two groups (experimental group and control group). In experimental group,bubble making was used. Data collection tools were: Demographic Information Questionnaire, andthe Scale of facial self reported anxiety. The analysis of the data was carried out through SPSS 16.Findings: Average score of anxiety in bubble making group was 2.9+1.5 before and 1.0+1.1 afterinjection. The average score in control group was 3.1+2.2 before and 2.4 + 2.1after injection. Therewas no significant difference between two groups of study regarding the average scores of anxietybefore the injection (p&gt;0.05) but there was a significant difference between two groups regardingthe average scores of anxiety after the injection (p&gt;0.05).Conclusion: The results of this study showed that bubble making is an effective method to decreaseanxiety resulted from the injection procedures.Key words: Anxiety, Bubble making, School-age Children, Distraction, Thalassemi

The effect of pregabalin and duloxetine treatment on quality of life of breast cancer patients with taxane-induced sensory neuropathy: A randomized clinical trial

Background: The primary side effect of adjuvant chemotherapy with taxanes is the taxane-induced peripheral neuropathy (TIPN), which may have substantial negative impacts on patients' quality of life (QOL). We investigated the effect of pregabalin and duloxetine on QOL of breast cancer patients who experienced TIPN. Materials and Methods: This was a randomized, double-blind clinical trial conducted at a chemotherapy center of Mazandaran University of Medical Sciences, Sari, Iran. Breast cancer patients 18 or more years old were included if they received paclitaxel or docetaxel and experienced neuropathy grade one or higher; and neuropathic pain score of four or more. Patients were treated with pregabalin or duloxetine until 6 weeks. Assessment of sensory neuropathy and QOL was performed at baseline, and 6 weeks after the initiation of the treatment. Results: At baseline, the mean score of global health status/QOL scale for pregabalin and duloxetine groups were 61 (standard deviation [SD]; 5.11) and 60.28 (SD; 5.44), respectively (P = 0.54). After 6 weeks, both interventions were associated with improvement of global QOL compared to baseline. The global health status/QOL score was not different between two groups after 6 weeks. While the emotional functioning was improved more favorably with duloxetine (P < 0.001); pregabalin was associated with more improvement in insomnia and pain scores (P = 0.05 and P < 0.001, respectively). Conclusion: Pregabalin as well as duloxetine improve the global QOL of breast cancer patients with TIPN. Different effects of treatments on subscale of QLQ-C30 could help clinicians to select the appropriate agent individually

The Effect of Activating Early Warning System on Motahari Hospital Preparedness A B S T R A C T

Materials and Methods: This is an interventional study, with a quasi-experimental pre-test and post-test design. This hospital was chosen by MOH as a benchmark for implementing the national disaster programs. The data collecting instrument was the hospital disaster preparedness checklist which evaluates 9 indexes of &quot;command and control,&quot; &quot;communications,&quot; &quot;safety and security,&quot; &quot;triage,&quot; &quot;increasing capacity,&quot; &quot;continuity of critical services,&quot; &quot;human resources,&quot; &quot;logistics and supply management,&quot; and &quot;recovery after disasters.&quot; Data of pretest and posttest were analyzed through nonparametric Wilcoxon test, using SPSS software, version 16. Results: The preparedness score before the intervention was 134, which represents the moderate level of hospital preparedness. The evaluation before and after the intervention indicated that &quot;recovery after disaster&quot; and &quot;triage&quot; had the least change with an increase of one score and the index of &quot;logistics and supply management&quot; had the maximum increase by 5 scores. The overall score of preparedness significantly increased from 134 to 159 (P&lt;0.05) after the intervention, which represents a change from moderate to high hospital preparedness. Conclusion: The preparedness of Shahid Motahari Hospital, which is the only specialized hospital of Tehran in burns, has significantly increased and reached a level of high preparedness to deal with disasters. This study indicates the importance of developing the activation of early warning system in hospitals for rapid and appropriate response to the disasters

The Effect of Activating Early Warning System on Motahari Hospital Preparedness

Background: One of the important aspects of hospital preparedness in disasters is its rapid early warning system. In this study, the activation of early warning system was evaluated under the monitoring of disasters workgroup of the Ministry of Health based on the national program of “hospitals preparedness in disasters” in Shahid Motahari Hospital.  Materials and Methods: The sample was composed of 801 adults exposed to the earthquake. Two months after the earthquake, all subjects were surveyed with measures administrated in a standard order as follows: demographic data sheet, disaster experiences scale (DES), general health questionnaire (GHQ), and symptom checklist 90-revised (SCL-90-R). Results: The results revealed that 23% of the survivors in the exposed group had ASD, 10% had anxiety symptoms, 7.5% depression, 4% MADD, 5% psychosomatic disorders, 10% phobia, 7% aggressive behavior, and 10% insomnia. Conclusion: This article has summarized the current status of information on mental disorders caused by experiencing or witnessing a life threatening severe earthquake. The experience of fear, helplessness, and panic during the earthquake, and the appraisal by the victims of serious psychological, social, as well as demographical consequences after the earthquake, were positively related to the subscale scores and the total score of GHQ, SCL-90-R, and DES

Multicenter Survey of Ramadan Fasting among Cancer Patient and Healthcare Professionals in the I.R. Iran

Background: Muslim cancer patients and healthcare professionals face several challenges about the necessity of fasting and its possible side effects during the holy month of Ramadan. We aimed to study the prevalence of fasting among cancer patients during Ramadan and opinions of health care professionals about fasting among cancer patients in Iran. Methods: We conducted a cross-sectional survey during the Ramadan (July-August) in 2013. Participants were 620 cancer patients and, 187 healthcare professionals in several cancer clinics from different provinces of Iran. We used self-administered questionnaires and collected data from patients, and healthcare professionals to collect data. We performed descriptive analysis by using Stata statistical software. Results: Out of 620 patients who participated in this study, 428 (69%) were women. 76 (13%) of patients had fasted for at least a day during Ramadan and, from which 41 (7%) had fasted whole months because of their religious belief. Among patients who had refrained from fasting, the reasons were lack of sufficient physical strength (403, 65%), excessive thirst (141, 23%). 275 (44%) of participants had consulted with their physician about fasting. We found that more than 50% of physicians advised against fasting for patients following surgery, pre-operation, recent hospitalization, and consumption of oral or intravenous chemotherapy. Most of the healthcare professionals (68%) believed that cancer survivors could not fast even if they have no signs or symptoms or side-effects after the treatment. Conclusion: Although most of the cancer patients refrain from fasting, some cancer patients practice fasting and face challenges during the holy month of Ramadan in Iran. Most patients consult about fasting in Ramadan with their doctor who has variable opinions about this issue. Development of guidelines for healthcare professional and cancer patients regarding Ramadan fasting is needed