Effects of an Orem-based Self-care Program on the Orem's Pattern of Lower-extremity Edema in Patients Undergoing Coronary Artery Bypass Grafting

Background & Objective: Coronary artery disease (CAD) is a cardiovascular disorder associated with long-term constraints in the patients' life. Open heart surgery is an effective treatment for CAD, and the postoperative complications require extensive care, especially by the patient. Self-care education plays a key role in this regard, particularly based on Orem self-care model. The present study aimed to investigating the effects of an Orem-based self-care program on Orem's pattern of lower-extremity edema in patients undergoing coronary artery bypass grafting (CABG). Materials and Methods: This clinical trial was conducted on 74 patients undergoing CABG at Kashani Hospital in Shahrekord, Iran, who were randomly allocated to the intervention and control groups using software. Data were collected using the need assessment form based on the Orem model, and edema was measured using a meter. Data analysis was performed in SPSS version 21. Results: The Orem-based self-care program reduced lower-extremity edema in the intervention group (before: 34.31±31, after: 32.14±2.87), while the changes in the control group were not significant (P>0.05). Conclusion: According to the results, nursing patterns (e.g., Orem's model) could be used to enhance self-care abilities in patients requiring long-term care. Keywords: Self-care, Orem Model, Edema, Coronary Artery Bypass Graftin

Investigating the effective factors on patients' escape from one of the public hospitals in Bushehr city in 2017-2018: A descriptive, cross-sectional study

چکیده زمینه و هدف: خروج از بیمارستان بدون اطلاع پزشک و پرسنل یا به عبارتی فرار از بیمارستان، یکی از چالش های  بزگ نظام سلامت محسوب می شود چرا که می تواند باعث ایجاد هزینه های اقتصادی برای سیستم و زیان جانی برای بیمار گردد . هدف از این مطالعه بررسی عوامل موثر در فرار بیماران و بار مالی ناشی از آن  در یکی از بیمارستان های عمومی شهر بوشهر می‌باشد. مواد و روش‌ها: این پژوهش یک مطالعه توصیفی- مقطعی است که در یکی از بیمارستان‌های شهر بوشهر انجام گرفته است. در این مطالعه، اطلاعات بیماران با روش سرشماری و با استفاده از یک چک لیست  استخراج گردیده است. این چک لیست حاوی سئوالات دموگرافیک، بالینی و اقتصادی می‌باشد. تحلیل داده ها از آمار توصیفی در محیط  نرم افزار spss  نسخه 25  بهره گرفته شد. یافته‌ها: بنابر نتایج حاصل از آنالیزهای آماری نرخ فرار از بیمارستان0018/0 برآورد می‌شود. یعنی به طور میانگین، هر ماه 6 نفر از بیماران فرار کرده‌اند. زیان مالی وارد شده به بیمارستان شهدای خلیج فارس بوشهر بابت فرار بیماران در سالهای 1396 و 1397 بالغ بر ده میلیارد ریال بوده است که سهم بیمارانی که بیمه داشتند در آن بیشتر از افراد فاقد بیمه بوده است. نتیجه گیری: نرخ فرار در بیمارستان مورد پژوهش کم بود. با این حال به دلیل این که فرار علاوه بر زیان مالی قابل توجهی که به بیمارستان ها وارد می‌کند می‌تواند مشکلاتی را برای خود بیماران، خانواده‌‌‌‌هایشان و نیز جامعه ایجاد کند، لازم است تلاش ها در جهت کاهش وقوع این معضل توسط مدیران  به کار گرفته شود.  Background and Aims: Absconding from hospitals presents big challenges to the health care systems, with consequences such as delay and incomplete treatment process. Also it may result in increased personal workload and the cost burden of health system. The aim of this study was to determine absconding rate and its driving factors in a public hospital in Bushehr city in 2017-2018. Materials and Methods: The present descriptive cross-sectional study was conducted in a general hospital in Bushehr. During the study, patients' information was extracted by a checklist from their medical records between 20 March 2017 and 1 March 2018 using census method. Ethical criteria such as confidentiality of patients' names and the hospital under study were observed. Results: Absconding rate was found to be 0.18 percentage. The highest number of escapes was noticed in emergency wards (137 and 92%), meaning that in average 6 persons have escaped each month. Mean age of the patients was 29.02 and they stayed 2.07 days in the hospital. The highest frequency of escape was observed in male patients and in singles which occurred in night shift. About 72%  (117) of patients did not have health insurance, but 88% of  unpaid amount was belonged to insured persons. The total amount of damages was estimated to be 1,411,950,080 Rials. The average cost per patient was also appraised to be 9,540,203 Rials. Conclusion: Despite the low escape rate at the studied hospital, the property damage was significant. Installation of gates and controlling the entry and exit of patients, coupled with increasing the number of physical protection staff and insurance offices, as well as reforming the clearance process and insurance laws are proposed to reduce the occurrence of this problem

The Inhibitory Effect of Connective Tissue Growth Factor Antibody on Postoperative Fibrosis in a Rabbit Model of Trabeculectomy

Purpose: To compare the efficacy of subconjunctival injection of an anti-connective tissue growth factor antibody (anti-CTGF) versus mitomycin-C (MMC) and placebo in reducing scar formation in a rabbit model of trabeculectomy. Methods: A total of 14 rabbits were included. Nine rabbits underwent trabeculectomy with subconjunctival injections of either anti-CTGF antibody, MMC, or balanced salt solution (BSS), each administered in three eyes, before peritomy. The anti-CTGF group received a repeated dose of the antibody five days after surgery. All nine rabbits were euthanized on day 14; the globes were stained with hematoxylin & eosin, Masson’s Trichrome, and immunohistochemistry for detecting alpha-smooth muscle (α-SMA) actin. RNA extraction was performed on five eyes of the remaining rabbits which included one eye without any surgery, one eye 5 hr after trabeculectomy without any injection, one eye five days after trabeculectomy without any injection, and two eyes five days after trabeculectomy with administration of MMC and BSS, respectively. Results: The mean bleb area in the anti-CTGF, MMC, and control groups was 3.8 ± 1.45, 5.9 ± 1.4, and 3.5 ± 1.9 mm2, respectively. Collagenous tissue was found to occupy the bleb area by 13.7%, 13.5%, and 18.5%, respectively. This ratio was significantly higher in the BSS group (P = 0.04). The expression of CTGF mRNA after 5 hr and five days in eyes undergoing trabeculectomy were significantly more pronounced as compared to the unoperated eye. The mean H-SCORE of α-SMA-immune reactive cells calculated as the grade of staining multiplied by the percentage of immune stained cells was 14.6, 10.22, and 140.58 in the anti-CTGF, MMC, and control groups, respectively. While the control eyes had a significantly higher score (Ps < 0.001), the anti-CTGF and MMC groups were comparable (P = 0.87). Conclusion: Based on the results of this animal study, the anti-CTGF antibody injection resulted in a significant reduction in collagenous tissue and myofibroblast cells after trabeculectomy

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Cataloging Archival Records of the National Library and Archives of Iran Based on the International Standard Archival Description (ISAD). 3. 2012; 21 (4) :114-134

Purpose: Records catalogues at the National Archives of Iran and the level of their conformity with the International Standard Archival Description (ISAD). The present research is aimed at identifying descriptive elements of the archival. Methodology: Standards, and interviews are employed for gathering research data. e results are presented in tables and -gures through descriptive statistical methods (frequency and percentage). The research community included researchers and experts in arrangement and description of records, manuals, and cataloging worksheets of the archival records existing in National Library and Archives of Iran. This research was based on analytical survey. A checklist, the rules of archival Findings: The research findings also show that information elements including “Author Name” (16.62%) and “Descriptors” (91.26%) are consistent with documentation tools. 8.8% of these information elements are not documented at all. In the eyes of the experts of arrangement and description of documents, cataloging of archival documents based on ISAD has improved the methods of organizing documents. Conclusion: Applying this standardized method of archival description has led to better retrieval of the related documents. This research displays the conformity of descriptive elements in the studied worksheets

Investigating of Underground Economy by Using Currency Ratio and Gap Between Expenditure and Income of the Family

Underground Economy is a series of value added activities which is not defined in the frame of formal economic. Private activities, private organizations and those kinds of market activities which, in some way, are not discovered by officials, totally, are making black or informal economic. Underground economy includes four sections: family, informal, irregular and illegal. The nature of unclearness of black economic, make it hard to estimate and study the economy, because of these, most of current measuring methods are indirect measuring of thise activities which are accompanied by limited assumptions. Through this research, in spite of considering different methods of measuring black economy, we estimate the amount of underground economy, using "currency ratio" and "Gap between expenditure and income of family". The gap between expenditure and income of family method is based on discrepancies between expenditure and income of families which is not reported in the national accounts. In "currency ratio" method we measuring the size of underground economy based on exchange of currency

Normal–Poisson distribution as a lifetime of a series system

In this paper, we introduce a new three parameter skewed distribution. This new class which is obtained by compounding the normal and Poisson distributions, is presented as an alternative to the class of skew-normal and normal distributions, among others. Different properties of this new distribution have been investigated. The density and distribution functions of proposed distribution, are given by a closed expression which allows us to easily compute probabilities, moments and related measurements. Estimation of the parameters of this new model using maximum likelihood method via an EM-algorithm is given. Finally, some applications of this new distribution to real data are given

Challenges, barriers and solutions for implementing clinical practice guidelines: a qualitative study in southern Iran

Background Identifying the challenges of implementing clinical practice guidelines (CPGs) can provide valuable information for decision-makers and health policymakers at the national and local levels. The implementation of CPGs requires the development of strategies to facilitate their use. This research aimed to determine the challenges, barriers and solutions for implementing CPGs from the expert point of view in Bushehr University of Medical Sciences.Methods This qualitative research uses content analysis conducted in 2022 in southern Iran. In-depth interviews were conducted with the physicians and experts in the health system. Interviewing continued until reaching the saturation level. Altogether, 22 experts were interviewed. The interview guide was used to explore experts’ opinions. All the interviews were recorded and then transcribed. Finally, coding and data analysis was done using MAXQDA 2022 software.Results The analysis revealed 4 main themes and 20 subthemes. The four main themes included challenges related to physicians, medical education, the health system and patients. The most common themes were the lack of sufficient training (related to the medical education system), equipment and infrastructure, and the lack of adaptation of clinical guidelines (related to the health system). The solutions included 4 main themes and 19 subthemes.Conclusion The most mentioned topic by the experts was training CPGs in medical schools. In Iran’s current medical education system, the training of CPGs is not included in the curriculum. It is proposed to reform the medical education system in Iran. In addition, health inequalities such as lack of access to equipment, supplies and insurance in under-resourced areas and disparities in research/training/medical education should be addressed to improve the validity of guidelines