[Effect of "Roy adaptation model" in physiologic aspect on the level of consciousness of patients in intensive care unit: a clinical trial]

Background and Aim: One of the indicators of recovery in the patients admitted to intensive care units is improvement of the level of consciousness. Various factors, including the type of care are effective in the changes of consciousness level of the patients. This study was conducted to determine the effect of nursing care plan based on "Roy adaptation model" in physiologic aspect on the level of consciousness of the patients in the intensive care unit

Material and Methods: This triple-blind clinical trial included 100 patients in the intensive care unit in 2017. Two ICU units in Sanandaj hospitals were selected randomly as intervention and control groups. Eligible patients in each unit were randomly assigned to intervention and control groups. The intervention group received nursing care plan based on "Roy adaptation model" and the control group received routine care. We measured level of consciousness for every patient based on the GCS for 7 days, twice a day. We used SPSS version 21 for data analysis

Results: The mean level of consciousness in the first three days and nights did not show any significant difference between the intervention and control groups. But there was a significant difference between the mean levels of consciousness from the fourth day and night on, between intervention and control groups [p <0.05]

Conclusion: Roy adaptation model was effective in increasing the level of consciousness after three days in the patients in the intensive care unit. Therefore, we recommend organized nursing care based on standard nursing models for all of the patients in the intensive care units

[Frequency of human papilloma virus genotypes among woman with genital lesions, in Sanandaj, Iran]

Background and Aim: genital wart is the most common sexually transmitted infection and its role in cervical cancer has been confirmed. The aim of this study was to determine the presence of human papillomavirus [HPV] and the frequency of its genotypes in the patients with genital lesions referring to the clinics in Sanandaj, Iran

Material and Method: this descriptive analytical study included 50 women with genital lesions referring to the clinics in Sanandaj City from February 2016 to February 2017. Biopsy samples were examined for four genotypes [HPV 16, 18 [high risk] and HPV 11, 6 [Low risk]] by PCR. Demographic information and risk factors were recorded in a questionnaire for every patient. Using spss v.20 software, data were analyzed by descriptive statistics. Fischer test was used to investigate the relationship between the risk factors and HPV infection

Results: the results showed that 28 cases [56%] were HPV positive. Among the four genotypes of HPV, HPV 6 was the most frequent [32%], followed by the types of 18 [12%], 16 [6%] and 11 [2%]. Co-infection of HPV-16 and 18 were found in 2 cases [7.1%].The mean age of the patients with HPV infection was 34.07 +/- 8.7 years and the mean age of the first sexual contact was 21.22 +/- 4.8 years. No significant association was found between the risk factors and HPV infection [P> 0.05]

Conclusion: considering the high prevalence of HPV infection and its asymptomatic course in many cases, early detection and treatment of the genital warts, especially HPV16 and 18, can lead to prevention of cervical cancer

[Investigation of the knowledge, attitude and performance of the physicians in regard to rational antibiotic prescription]

Background and Aim: excessive use or misuse of antibiotics leads to important consequences such as increased cost of treatment, bacterial resistance, treatment failure, drug toxicity and increased morbidity and mortality. Use of guidelines can result in increased knowledge of the physicians and decreased prescription of antibiotics with resultant change in the attitudes of the physicians towards this policy

Materials and Methods: this cross-sectional study included 356 physicians and was conducted in Sanandaj in 2015. The sampling method was census. The final questionnaire included 7 questions to assess knowledge, 18 questions to measure attitudes, [by means of a 5-point Likert Scale from very strong agreement to very strong disagreement], and 12 questions to assess performance. The reliability of the questionnaire was 54%. Using SPSS20 software, frequency and mean score of the questions were calculated

Results: among 356 questionnaires, 44.2% were filled out by specialists and 45.2% by the physicians who had graduated more than seven years ago. 56% of the physicians chose the correct answer for the questions on knowledge, and 25% of the physicians had knowledge about antibiotic resistance. 97.3% of the physicians agreed that antibiotics in our country have been used in excess. In this study, 233 [65.5%] physicians had high knowledge and selfconfidence and 19.7% expressed low or lack of self-confidence about antibiotic prescription. WHO guideline and antibiotic guideline had been considered useful by 56% and 54.5% of the participants respectively. 49.9% of the physicians had not participated in any training course on antibiotic prescription. The highest and lowest frequency rates about sources of knowledge on antibiotic prescription belonged to internet [63.2%] and information provided by pharmaceutical companies [30.3%] respectively

Conclusion: considering the average level of knowledge of the doctors on antibiotic prescription and lack of participation of half of the subjects in training courses on antibiotic prescription after, attention to training courses with proper planning is recommended

frequency of osteoporosis and osteopenia in the paitents with beta thalassemia major and correlation of biochemical markers with bone densitometry results in these patients in Sanandaj

Background and Aim: Beta thalassemia is one of the most common single gene disorders in the world which occurs due to a defect in the beta globin chain synthesis

In general, the majority of the patients with thalassemia, are suffering from decreased bone density

Osteoporosis is characterized by low bone mass and disorder of osteogenesis resulting in reduced bone strength Considering the serious consequences of osteoporosis, this study was performed to evaluate the prevalence of osteoporosis in the patients with beta thalassemia major

Materials and Methods: This study included 46 beta thalassemia patients above 5 years of age who had been admitted to the oncology ward of Besat Hospital in Sanandaj. Chemical biomarkers were measured and the results of densitometry of the lumbar spine and femoral head were investigated for the presence of osteoporosis, osteopenia and normal findings. Using SPSS 20 software, we used one-way analysis of variance to assess the association between chemical biomarkers

Results: The mean [SD] age was 19.8 [7.7] years, 24 patients [52.2%] were women and 32 [69.6%] were above 15 years of age. In this study, the most frequent findings of densitometry were osteoporosis [34.8%] and normal lumbar spine [34.8%]

Comparison between the chemical biomarkers and foldings of the densitometry of the femoral head revealed different levels of ferritin in these patients [P = 0.011]. This difference was observed in the patients who had osteoporosis and normal densitometry results [P = 0.009]

Conclusion: The results of this study showed no significant statistical relationship between chemical biomarkers and the densitometry results. Therefore, use of bisphosphonate is recommended for prevention of bone damage

[Use of Single Index Model for estimation of survival of the patients with acute myocardial infarction]

The Cox proportional hazard model is the standard approach for analyzing survival data in many cases. One restriction of this method, however, is that it assumes that the log of the hazard function relates to the covariates through a linear function. As a consequence, it fails to estimate efficiently the effect of the non-linear terms. But we can estimate the survival rate by using spline functions. Our goal is to investigate the appropriateness of an alternative method, the so-called single index model, for estimation of the survival rate of the patients with acute myocardial infarction. This was a descriptive analytical cohort study which included 650 subjects with acute myocardial infarction. The patients were followed up for one year to ensure survival or detect death events. Data were recorded in a pre-defined check list. In this study the relationship between the log of the hazard function and covariates were considered unknown. We estimated the coefficients of the model by using the polynomial spline and penalized partial likelihood. Data analysis was carried out by using R version 2.12 software and significant levels were considered 0.05. We found the Cox model with unknown link function to have larger log likelihood than the standard Cox model. The effects of estimated parameters in both models were relatively different. Effects of diabetes and arrhythmia in Cox model with unknown link function were significant [P<0.05]. In standard Cox model unlike Cox model with unknown link function the age was significant [P<0.05]. Considering the results of this study Cox model with unknown link function could estimate the effect of factors such as diabetes and arrhythmia in the survival of the patients, in addition to the effects of streptokinase and ejection fraction

[Effect of supplemental oxygen on the incidence and severity of nausea and vomiting in the patients after cesarean surgery under spinal anesthesia]

Nausea and vomiting are common complications after surgery occurring in 20-70 percent of total surgeries and depends on factors such as anesthesia method and hemodynamic status, oxygen concentration, pain, etc. In some studies use of higher concentrations of oxygen prior to surgery has resulted in decreased incidence of nausea and vomiting and in some other studies such results had not been verified. In the present study, the effects of supplemental oxygen has been assessed on the incidence and severity of nausea and vomiting in the patients after cesarean surgery under spinal anesthesia. This study was a randomized clinical trial and 122 women who were candidate for cesarean surgery were assigned randomly into intervention and control groups. Intervention group received 80 percent O2equivalent to 12 liter per minute, continuously during surgery and after surgery in recovery room, and alternatively 6 hours by use of ventury mask in the ward. The control group received 30 percent O2, equivalent to 3-5 liters per minute with a regular mask as a routine measure. The incidence and severity of nausea and vomiting was recorded during surgery, up to 6 hours after surgery, in the recovery room and in the postpartum ward. According to the results, the incidence of nausea during surgery showed no significant relationship but it showed a significant difference in the recovery room and at the postpartum ward in the intervention and control groups [p<0.01]. Incidence of vomiting during surgery and at the postpartum ward in the intervention and control groups had no significant difference but it revealed a significant difference in the recovery room [p<0.001]. There was a significant difference in the severity of nausea in the intervention and control groups during surgery, in recovery room and after 6 hours of surgery in the postpartum ward and the severity of nausea was higher in the control group [p<0.05]. This study demonstrated that supplemental oxygen therapy during and after surgery by spinal anesthesia technique was not effective for the prevention of nausea. There was only a significant statistical difference in the rate of vomiting in the recovery room between the two groups. Use of supplemental oxygen decreased the need for analgesic drugs in these patients

Assessment of liver function test change after open heart surgery

Open heart surgery requires using cardiopulmonar bypass [CPB]. CPB stimulates complement, coagulation and immune systems and non-pulsatile flow has an important effect on body organs, like liver. Activation of this system produces severe inflammatory reaction with subsequent organ damage. This study was designated to examine the influence of CPB on simple liver function test. A total of 100 patients with coronary artery disease [CAD] and valvular heart disease were scheduled for surgery and entered in a clinical study to assess the effects of intra-operative variables on simple liver function tests [SGOT, SGPT, alkaline phosphatase, and bilirubin] measured after three consecutive days with an auto-analyzer device. Patients with a past medical history of right heart failure, jaundice or hepatitis were excluded from our study. Independent and continuous variables, such as age, gender, pump time, temperature in pump, transfusion, were measured and recorded, and effect of these variables on mean values of liver function test after operation was evaluated by generalized linear method [GLM] and two way methods. This test entered to model as dependent variables and other variables as fixed or co-variables. The mean values of liver function test before and after operation were compared by ANOVA and Turkey's post hoc test and p-value <0.05 was considered significant. The pump hypotension [BP<50mmHg] had an effect on SGPT 1 and SGOT 2 and SGOT 3 [P<0.004]. Change of SGOT 2 test was significant in the pump time longer than 100 minutes. SGOT 1, SGOT 3, SGPT 1, alkaline phosphatase 1 changes related to CPB temperature was seen in temperature less than 28, rise of alkaline phosphatase 1,2, 3 was significant [P<0.01] with long anesthesia time. Type of operation had a significant effect on direct bilirubin 2, 3 and type of pump had an effect on SGOT 2 and direct bilirubin 1. Sex had effect on SGOT 2 but age did not have any effect on liver function test. Transfusion volume raised SGOT 1 and alkaline phosphatase 1 and direct bilirubin 2 and long pump time raised SGOT 2. Age had no influence on liver function test. The most sensitive tests to find hepatic injury with hypothermia were SGPT 1 and alkaline phosphstase 1 and SGOT 1. In CPB hypotension, SGPT 1, 2 tests were significant and in long pump time, SGOT 2 was sensitive for knowing hepatic cell damage