Opioid-Induced Hyperalgesia (OIH): Case Study of a Woman with Metastatic Colon Cancer

Pain is an unpleasant experience and a subjective term that is associated with tissue damage. Cancer patients experience pain for a myriad of reasons, from disease related to treatment causes and unrelated to both of these categories. Opioids are the mainstay in the treatment of moderate to severe cancer pain. Progressive opioid dose increases can cause opioid-induced hyperalgesia (OIH). OIH has no definite management, here we present a 47-year-old cancer patient with OIH and her management

Cost effectiveness of different cervical screening strategies in Islamic Republic of Iran: a middle-income country with a low incidence rate of cervical cancer

Objective: Invasive cervical cancer (ICC) is the fourth most common cancer among women worldwide. Cervical screening programs have reduced the incidence and mortality rates of ICC. We studied the cost-effectiveness of different cervical screening strategies in the Islamic Republic of Iran, a Muslim country with a low incidence rate of ICC. Methods: We constructed an 11-state Markov model, in which the parameters included regression and progression probabilities, test characteristics, costs, and utilities; these were extracted from primary data and the literature. Our strategies included Pap smear screening and human papillomavirus (HPV) DNA testing plus Pap smear triaging with different starting ages and screening intervals. Model outcomes included lifetime costs, life years gained, quality-adjusted life years (QALY), and incremental cost-effectiveness ratios (ICERs). One-way sensitivity analysis was performed to examine the stability of the results. Results: We found that the prevented mortalities for the 11 strategies compared with no screening varied from 26% to 64%. The most cost-effective strategy was HPV screening, starting at age 35 years and repeated every 10 years. The ICER of this strategy was $8,875 per QALY compared with no screening. We found that screening at 5-year intervals was also cost-effective based on GDP per capita in Iran. Conclusion: We recommend organized cervical screening with HPV DNA testing for women in Iran, beginning at age 35 and repeated every 10 or 5 years. The results of this study could be generalized to other countries with low incidence rates of cervical cancer

The Lack of Systematic Training for Health Care Providers, A Challenge for Providing Pediatric Palliative Home Care: A Comparative Study

Background: The growing prevalence of chronic diseases in children has increased their need for palliative care. We aimed to compare pediatric palliative care and home care training in Iran and in the selected countries. Materials and Methods: This comparative study was conducted based on the classifications of palliative care for children and using databases such as Scopus, Science Direct, Ovid, ProQuest and Medline, websites affiliated with communities and associated with palliative care and home care services and according to the framework of World Health Organization’s Public Health Road Map. The selected countries consist of England, Canada, Australia and South Africa, where home care services are provided for children in addition to palliative care. Results There is a pediatric palliative care training program for doctors in the selected countries. Home care is part of these programs in these countries. Despite the lack of an independent nursing course in postgraduate education in England, Canada, and Australia, community health nurses are responsible for providing care responsible to provide care for children with life-threatening diseases in the community and at home. In South Africa, a home-based palliative care training and support package for children was designed for community care workers. In Iran, pediatric palliative care is in the early stages and home care is evolving as a need. Conclusion Education is the most important factor for integrating home care and pediatric palliative care into the health system. In countries with advanced pediatric palliative care, the knowledge and skills of care providers have been considered. In Iran, revising medical and nursing curriculums and the integration of palliative care and home care programs into the curriculum are essential

Effect of an Educational-Supportive Program Based on Roy Adaptation Model on Marital Satisfaction in Mastectomy Patients Receiving Chemotherapy

Background: Regarding nurses' significant role in improving quality of marital life in mastectomy patients and their families, implication of the adaptation model can help nurses reaching this goal. Aim: This study aimed to determine Effect of an educational-supportive program based on Roy This quasi-experimental study was performed on 69 mastectomy patients receiving chemotherapy in 2013 in clinical services in Tehran, Iran. The samples were randomly allocated to two groups. The data collection instrument was ENRICH Marital Satisfaction scale (2011). In the experimental group, maladaptive behaviors and their stimuli were determined by the questionnaire, and then adaptive strategies were implemented in 45 days. The program was based on support (patients instruction), peer group, weblog, meeting with the participants’ spouses, and three-month follow-up using behaviors checklist. Control group patients received the regular treatment sessions. T-test, Pearson’s correlation coefficient, Spearman's rank correlation coefficient, and Chi-square tests were run, using SPSS version 19. Results: In experimental group, paired sample t-test reflected an increase in marital satisfaction from 24.7±2.6 before to 32.9±3.5 after the intervention (P=0.03). However, no significant differences were observed in the control group from 26/7±4/6 before to 26/5±4/8 after the intervention in this regard (P=0/63).   Implications for Practice: Roy Adaptation Model can be used as a framework for designing educational-supportive programs to improve quality of marital life in mastectomy patients receiving chemotherapy

Attitude toward end-of-life care in emergency medicine residents- can a short workshop make a difference?

Background There is a growing demand for palliative care (PC) in Emergency departments (ED) as the number of patients who need end-of-life (EOL) care is increasing. Despite significant variability amongst residency programs, there is a lack of structured core curriculum for PC/EOL care in most emergency medicine (EM) training programs, which often do not meet the needs of EM physicians. In this study, we evaluate the effect of a short EOL care workshop on changing the attitude of Iranian EM residents towards EOL care in ED. Method In this prospective before/after educational study at Tehran University of medical science, we enrolled 40 EM residents using a random sampling method. We obtained demographic and practice background information, and participants underwent a half-day PC training workshop designed by an expert panel. We administered a translated and validated Standard PEAS (physician End of Life Care Attitude Scale) questionnaire before and four weeks after an educational intervention. Baseline and differences in attitude were reported and compared by paired t-test, repeated measure ANOVA, and ANOVA. Results None of the participants had prior experience of formal PC training. All of the 40 participants completed the follow-up questionnaire. Baseline attitude was not different among demographic groups. The mean (SD) PEAS score before and four weeks after the workshop was 86.9 (5.8) versus 89(6.9), respectively (P = 0.023). Residents with no previous close exposure to a terminal illness in their family members had significantly more attitude change than those with such an experience (P = 0.045). Conclusion A brief educational intervention improved EM residents’ attitudes toward EOL care. The optimal design and characteristics of this educational intervention yet remain to be defined by further studies

مراقبت تسکینی مبتنی بر معنویت در مبتلایان به سرطان از دیدگاه پرستاران: مطالعه کیفی

Introduction: Palliative care concept is one of the most important concepts in cancer nursing and cancer patients require palliative care. Also, spirituality has an important role in caring of these patients. The purpose of this study was identifying viewpoints of nurses regarding spirituality- based palliative care in cancer patients. Method: This study done with qualitative approach and using content analysis method. In this study, 14 nurses were selected through purposive sampling and face- to- face interviewed with semi structured interview. After data collection, all interviews were transcribed and reviewed and categories extracted. At first, similarity in meanings were reviewed and based on centralization arranged in a sub- category. Then with reviewing again relevant sub- categories arranged in a category. Results: In general, original categories in the spirituality- based palliative care in cancer patients encompass; promotion of spirituality wellbeing and spirituality management. Promotion of spirituality wellbeing has 2 sub - categories consist of religious strategies promotion and protection of spiritual values and believes. Also, spirituality management has 2 sub- categories consist of trying to connect patient with god and spirituality support. Conclusions: Content analysis of spirituality- based palliative care in cancer patients revealed the required conditions for this type of caring in cancer based on perception of nurses. The results of this study suggest that point of view nurses, promotion of spirituality wellbeing and spirituality management has important role in spirituality - based palliative care in cancer. The findings of this study will give nurses a greater knowledge about spirituality- based palliative care in cancer patients, lead to a better understanding of the spiritual needs of these patients, and ultimately help improve the nursing practice.مقدمه: مراقبت تسکینی یکی از مهم‌ترین مفاهیم در پرستاری از بیماران مبتلا به سرطان می‌باشد و این بیماران به مراقبت تسکینی نیاز دارند. معنویت نیز نقش مهمی در مراقبت از این مبتلایان دارد، لذا هدف این مطالعه شناسایی دیدگاه پرستاران از مراقبت تسکینی مبتنی بر معنویت در مبتلایان به سرطان بوده است. روش: مطالعه حاضر با رویکرد کیفی و با بهره‌گیری از شیوه تحلیل محتوا انجام شد. مشارکت‌کنندگان شامل 14 پرستار بودند که به روش نمونه‌گیری هدفمند وارد مطالعه شدند و مورد مصاحبه‌های چهره به چهره و نیمه ساختارمند قرار گرفتند. بعد از گردآوری داده‌ها، تمام مصاحبه‌ها پیاده‌سازی شدند، مورد بازنگری قرار گرفتند و سپس طبقات استخراج گردید. در ابتدا شباهت‌های معنایی مورد بازنگری قرار گرفت و زیر طبقات مشخص شدند و سپس در بازنگری مجدد زیرطبقات مرتبط در یک طبقه قرار گرفتند. یافته‌ها: طبقات اصلی در تحلیل محتوای مراقبت تسکینی مبتنی بر معنویت از مبتلایان به سرطان شامل ارتقای سلامت معنوی و مدیریت معنوی بودند. ارتقای سلامت معنوی دربردارنده زیر طبقات ارتقای راهبردهای مذهبی و پاسداشت ارزش‌ها و باورهای معنوی بود و مدیریت معنوی نیز دربردارنده تلاش برای پیوند بیمار با خدا و حمایت معنوی بوده‌اند. نتیجه‌گیری: تحلیل محتوای مراقبت تسکینی مبتنی بر معنویت از بیماران مبتلا به سرطان، شرایط لازم برای این مراقبت را مطابق دیدگاه پرستاران نشان داد. از دیدگاه پرستاران، ارتقای سلامت معنوی و مدیریت معنوی نقش مهمی در مراقبت تسکینی مبتنی بر معنویت از مبتلایان به سرطان داشته‌اند. یافته‌های این مطالعه، به پرستاران در جهت شناخت بیشتر مراقبت تسکینی مبتنی بر معنویت از مبتلایان به سرطان، درک بهتر از نیازهای معنوی این بیماران و در نهایت ارتقای عملکرد آنان در بالین یاری می‌رساند

Using hydrogen peroxide as a bladder irrigation solution for clot evacuation

Gross hematuria or macroscopic hematuria is a high risk urologic condition that might occur in different settings. In the case of continued gross hematuria, blood clot size may grow and lead to complete obstruction of urinary outflow. Placement of three-way catheter, continuous bladder irrigation with normal saline, and cystoscopy are conventional treatments. Here we introduce a case with urinary obstruction who did not respond to conventional therapies. A subject of Hodgkin lymphoma with urinary obstruction caused by heavy gross hematuria was presented to emergency department. Three-way catheter was inserted to facilitate urination. However, there was no urinary drainage and bladder was distended. Consequently, 100 ml solution of hydrogen peroxide 0.15% was prepared and administered into the bladder to irrigate and evacuate the clots. A single intravesical infusion of hydrogen peroxide rapidly resolved urinary obstruction and improved patient distress. After administration of hydrogen peroxide solution, blood clots and bloody urine were evacuated successfully. These findings suggest that an intravesical injection of hydrogen peroxide can induce dissolution of blood clots and may be a simple and efficient therapy for urinary obstruction due to gross hematuria

Ethical Issues in the End of Life Care for Cancer Patients in Iran

Background: In the recent years, advances in medical technologies for end stage cancer patients’ care have affected the end-of-life decision-making in clinical practice and exposed oncologists to serious ethical dilemmas. But little is known about oncologists' viewpoints in our country regarding their ethical problems in this mention. We aimed to clarify the ethical dilemmas which Iranian oncologists may face in our health care setting and to determine factors influencing decision-making process.Methods: In this qualitative study, a phenomenological approach was used. We interviewed 8 cancer specialists in teaching hospitals in Iran and used content analysis to identify codes and categorize themes in the data.Results: During the process of analysis, three main themes emerged about ethical dilemmas in end of life care for advanced cancer patients: illness factors, socio-cultural context and patient-physician relationship. Cancer specialists identified ethical problems on several main issues, the most important of which were telling the truth in Iranian cultural context, uncertainty in end stage definition, multidisciplinary team working and cost consideration in Iranian health care system.Conclusion: Health care and insurance system in Iran face to end of life care challenges; therefore, health care providers and policy makers need to allocate appropriate resources and programs to improve quality of care in terminal stages. Appropriate physicians’ communication skills training, multidisciplinary team working and supplementary insurance services that provide essential health care can improve the quality of care of patients with end stages of cancer. The findings of this study can help us to provide ethical policies for decision-making in end-of-life care

Cost-effectiveness of 11 different strategies for cervical screening.

<p>Strategies standing on the curve are dominant strategies, indicating that they cost less and had more effect. Strategies located out of the curve are dominated strategies, i.e. their costs were much higher than their effects.</p