Inhaled Beclomethasone with or whiteout Montelukast in the Management of Pediatric Persistent Asthma

BACKGROUND AND OBJECTIVE: Inhaled corticosteroid is the first line of treatment for asthma which has its own side effects. By contrast, Montelukast has fewer complications and is easier to use because of its tablet-like form. Hence, the present study aimed to compare the effectiveness of inhaled beclomethasone with and without oral Montelukast in the control of children’s persistent asthma. METHODS: This clinical trial study was performed on 84 children with asthma referring to Amirkola Children's Hospital in two groups. One group of patients received inhaled beclomethasone with Montelukast. The another group was treated with only inhaled beclomethasone alone. Before and 3 months after the treatment, FEV1, IgE, eosinophilia, night sleep quality, and school absenteeism status were measured in both groups. FINDINGS: FEV1 values presented no significant difference between the two groups before the treatment, but it significantly increased in both groups three months after the treatment (p=0.000) (from 71.8±2.1 to 89.4±2.1 in the combinative treatment group and from 72±3 to 88.3±2.4 in the beclomethasone group). However, there was no significant difference between the two groups in this regard (p=0.146). CONCLUSION: The results of this study showed that although the increase in FEV1 was similar in the two groups after treatment, but due to the better therapeutic acceptance in the combination therapy group, combination therapy could be used to control children's asthma

Relationship between spirituality and death anxiety in patients with cancer undergoing chemotherapy

Background and purpose: Cancer is a highly prevalent disease that could cause psychological and emotional complications such as death anxiety. On the other hand, spiritual well-being is an inherent element of health and may enhance patients’ adaptability to cope with their disease and associated anxiety. This study was done to determine the effect of spirituality in predicting death anxiety in patients with cancer. Materials and methods: This descriptive-correlational study was done in patients (n=100) with cancer in Sari, Iran 2017. The participants were selected using convenience sampling in Imam Khomeini Hospital. Data was collected by a demographic questionnaire, Templer Death Anxiety Scale (DAS), and Spirituality Questionnaire (SQ). The data was analyzed using Pearson correlation and Regression analysis. Results: The death anxiety score in 49 of the patients was high (higher than 8). The mean score for death anxiety and spirituality was 8.39±2.96 and 85.44±11.59, respectively. There was no relation between death anxiety and spirituality (P>0.05), but there were relations between death anxiety and dimensions of spirituality. Death anxiety level was highly correlated with spiritual practices dimension but had the least correlation with spiritual needs. Higher levels of spiritual practices can decrease the level of patient’s death anxiety. Conclusion: According to findings, spiritual practices dimension is a suitable predictor of death anxiety in patients with cancer, therefore, spirituality training might decrease the incidence or level of their death anxiety. © 2018, Mazandaran University of Medical Sciences. All rights reserved

Effect of life style modification on adherence to diet and hypertension in hypertensive patients

Introduction: Hypertension is one of the most important health problems which cause significant morbidity and mortality and it can be affected by social factors. Life style modification is an effective strategy to manage blood pressure. This study aimed to determine the effect of educational program of lifestyle modification on adherence to diet and hypertension in hypertensive patients. Materials and Methods: This randomized clinical trial study was done on patients with hypertension referred to Heart clinic at Sayyad hospital of Gorgan in 2015. Patients recorded adherence to diet daily (including 5 subgroups; salt consumption, fatty foods, fruits, fresh vegetables, and low fat dairies), based on the obtained scores they were considered as poor, average and complete adherence. 98 eligible patients with average and low adherence was chosen via convenience sampling and allocated into control and intervention groups using stratified random allocation (n=49). For modifying life style, face to face education took place for intervention group twice a week, over a 2-week period. Each session lasted about 2 hours. Patients in the control group received routine care without any intervention. Educational content relevant to hypertension was including description of hypertension, modifying life style (daily exercise and physical activity, smoking cessation, weight control, improving sleep pattern, decreasing anxiety and stress management), use of prescribed drugs, attend to follow-up appointments, and following recommended diet. Then, adherence to diet was recorded daily for two weeks in both groups. Results: Result showed that education of life style modification was effective on diet adherence (P<0.001). Also the systolic and diastolic blood pressure was decreased after intervention (P<0.001). Conclusion: Educational program for improving diet adherence as a practical life style modification may result to decrease blood pressure of patients with hypertension. © 2018, Semnan University of Medical Sciences. All rights reserved

Researchable clinical problems from the viewpoint of healthcare providers: A qualitative study

Background and purpose: There is lack of concordance between researchers' interests and clinical problems. This study aimed at explaining researchable clinical problems from the perspective of healthcare providers to provide a better understanding of the issues that could be solved by the health system. Materials and methods: This qualitative study was carried out in 27 healthcare providers in selected hospitals affiliated to Golestan University of Medical Sciences, 2017. The participants were selected by purposive sampling. Focused Group Discussion (FGD) was used to collect the data. The participants explained their experiences through three FGDs which began with a broad open-ended question and further probing questions were used. Interviews were recorded and transcribed verbatim. Data were analyzed using qualitative content analysis. Results: The participants aged 25-53 years old with 2-26 years of clinical experience, among whom 59 were males. The analysis of data led to the development of four main themes. The researchable clinical problems included clinical problems associated with health system structure, the status of healthcare providers, the status of service delivery in the health system and needs assessment, and problems associated with clinical processes. Conclusion: Current study suggests that after determining the priority of researchable problems regional issues should be addressed in designing and performing clinical researches. © 2019, Mazandaran University of Medical Sciences. All rights reserved

Physical Restraint and Associated Factors in Adult Patients in Intensive Care Units: A Cross-sectional Study in North of Iran

Background/aim: Patients in the intensive care units (ICUs) are at high risk of developing delirium and agitation. Physical restraint (PR) has increased to control these patients which accompanies by adverse consequences. The aim was to determine the PR use and associated factors in patients hospitalized at the ICUs in the North of Iran. Materials and methods: In this cross-sectional study, a total of 272 patients in 3 ICUs of 5 Azar referral hospital affiliated to Golestan University of Medical Sciences (Gorgan, Iran) in 2018 were included. Confusion assessment method for the ICU (CAM-ICU), Richmond Agitation-Sedation Scale (RASS), acute physiology and chronic health evaluation II (APACHE II), and Glasgow Coma Scale (GCS) were used to evaluate delirium, sedation level, disease severity, and level of consciousness, respectively. Analysis was done by STATA version 14.2 (StataCorp LP, College Station, Texas), univariate and multiple analyses. Results: Data from 272 patients were analyzed (mean age of 45.8 ± 21.3 years). PR was used for 74.5 of patients. Restrained patients had more severe disease mean of APACHE II score, 20.20 (7.5) vs 11.6 (7.1), longer length of stay mean of 10 (5.5) vs 5.5 (4.6) days, and lower level of consciousness mean of GCS score, 8.7 (3.5) vs 13.5 (3.3) than patients without it. CAM-ICU was positive in majority of patients (79.5 vs 10.4%) and agitation level of RASS score was higher in restrained patients (31.7 vs 3.0%). Associated factors in multiple analysis were use of sedative and psychoactive drugs odds ratio (OR), 2.85; 95% confidence interval (CI): 1.04�7.82, presence of delirium (OR, 15.13; 95% CI: 4.61�49.65), deep sedation (OR, 0.04; 95% CI: 0.00�0.45), and GCS score (OR, 0.69; 95% CI: 0.53�0.9). Conclusion: This study revealed the high use of PR in the ICUs, and use of sedative and psychoactive drugs, presence of delirium, deep sedation, and GCS score were such associated factors. © The Author(s). 2022

Improvement of Nurses� Clinical Practice in Neonatal Pain Management: A Protocol of Evidence-Based Intervention

Background: Despite the expansion of knowledge of neonatal pain assessment and management, there is still a considerable gap between nurses' clinical practices in Iran and available evidence. The aim of this study was to develop an evidence-based protocol for neonatal pain management and to evaluate its effectiveness on nurses' clinical practice. Methods: The present study will be based on the Johns Hopkins nursing evidence-based practice (JHNEBP) model and the three stages of practice question and project planning, evidence, and translation (PET). In this way, after forming an interprofessional team, clinical practice questions will be defined, and the main stakeholders will be identified. Then, the types, levels, and quality of evidence will be assessed to summarize their final strength using the proposed tools of the model, and finally, recommendations will be developed. In the translation phase, the recommendations will be implemented during a stepped wedge cluster randomized trial, and its implications for nursing practices in the management of pain in hospitalized neonates will be evaluated. Results: The results of this study will lead to the production of an operational and applicable protocol in the management of pain in hospitalized neonates. It can provide the basis for improving the clinical practice of nurses and subsequently improving the quality of neonatal care. Conclusion: One of the strengths of this study is the use of an interprofessional team approach, considering the clients' priorities, and the improvement of organizational culture in order to endeavor for knowledge translation and change in clinical practice. © 2022, Golestan University of Medical Sciences. All rights reserved

The anxiety of patients under regional anesthesia: operating room healthcare providers’ point of view

Background:  Preoperative anxiety is a widespread phenomenon in anesthesia, a challenging issue for the caring team in evaluating and managing patients’ anxiety. This study aimed to determine the operating room (OR) healthcare providers’ point of view on the patients’ anxiety under regional anesthesia. Methods:  This cross-sectional study was conducted on 203 OR healthcare providers in the adult public educational hospitals of Golestan University of Medical Sciences, Gorgan, Iran, from April to November 2021. Eligible OR healthcare providers, including nurse anesthetists (104), surgical technologists (82), and anesthesiologists (17), were recruited through the census method. Data were collected using anesthesiologists’ perception of patients’ anxiety under a regional anesthesia questionnaire developed by Jlala (2010). The impact score was determined to ensure the face validity of the Iranian version of the questionnaire, and ten healthcare providers checked it qualitatively. The average score of the content validity index (CVI=0.978) and content validity ratio (CVR=0.978) were acceptable. The instrument’s internal consistency was evaluated using Cronbach’s alpha coefficient (α =0.675). Data were analyzed in SPSS software version 18 using Fisher’s Exact, Chi-Square, and Kruskal-Wallis tests. Results:   There were no differences in most questionnaire items between healthcare providers’ views based on their professional roles (P<0.05). More than half of the patients who were candidates for spinal anesthesia were anxious (57.1%). Incorrect information from non-experts, family, friends, and the media often increased patients’ anxiety (59.3%). The most commonly used method for managing patients’ anxiety is sedation using medication (40.9%) and relaxation techniques (35.5%). Conclusions: Healthcare providers considered that anxiety of patients who were candidates for regional anesthesia was a prevalent problem that can be affected by various factors. All necessary facilities should be considered to create and maintain patients’ comfort in the OR

Morphological and Molecular Identification of Emerged Lophomonas blattarum Infection in Mazandaran Province, Northern Iran: First Registry-Based Study

Background: In the last decade, several cases of bronchopulmonary lophomoniasis (BPL) have been recorded. Little information is available about epidemiological aspects on Lophomonas infection among BPL patients. The present study was aimed to investigate the prevalence of Lophomonas spp. infection in patients who were referred to the Iranian National Registry Center for Lophomoniasis (INRCL), using morphological and molecular tests. Subjects and Methods: We examined patients enrolled in the INRCL from 2017 to 2019 at the Mazandaran University of Medical Sciences, northern Iran. All bronchoalveolar lavage fluid (BALF) and two nasal discharges of the patients were examined by both microscopic and small-subunit ribosomal RNA (SSU rRNA) PCR methods. To confirm the species of Lophomonas, two positive samples were sequenced. Results: In this study, 321 specimens (including 319 BALF and 2 nasal discharges) were microscopically examined. Lophomonas spp. was found in 45(14) (n = 44 BAL; n = 1 nasal discharge). The mean age of infected patients was 54.9 ± 17.1 years. The following morphological characteristics were observed in both fresh and Papanicolaou-stained smears to identify Lophomonas spp. All microscopically positive specimens were confirmed with genus-specific PCR technique. The obtained sequences were deposited in Gen Bank under the accession numbers (MN243135-36). The BLAST analysis of our two sequences with the only available sequence in the Gen Bank of the Thailand strain of L. blattarum, showed identity of 99�100 and 98.51, respectively. Conclusion: To the best of our knowledge, this is the first registry-based study regarding lophomoniasis worldwide. According to our study, the conventional PCR test is an available and reliable tool for confirming the Lophomonas parasite in clinical samples. Moreover, the results confirmed that L. blattarum is circulating at least in our region. © 2021, Witold Stefa�ski Institute of Parasitology, Polish Academy of Sciences

Evaluation of Metal Forming Machine Alternatives Used for Production Activities with MOORA Method

This study aims at evaluating of machine alternatives that the companies need for metal forming with MOORA method. Evaluation criteria have been determined as engine power, approach speed, working speed and return speed. Preference ranking of 61 different models have been analysed by taking into account all of these criteria together from the viewpoint of the companies.</p