Accuracy of the dose delivery in prostate cancer patients-using an electronic portal imaging device [EPID]

Background: To correct patient positioning errors [setup errors] during prostate cancer treatment using EPID and fiducial gold markers, to improve the accuracy of the dose delivery in these patients

Materials and Methods: Fifteen patients with localized prostate carcinoma after implantation of fiducial gold markers in their prostate gland underwent the five-field IMRT planning technique. The plan was prepared in accordance with ICRU 50 guidance [PTV to receive 95-107% dose]. The software program reconstructed the three-dimensional position of the markers from the different Beams Eye Views [BEV]. The discrepancies of the seeds' positions [prostate surrogate] between plan and daily images were calculated three dimensionally. Then, necessary corrections were applied to match the prostate fiducial markers in the portal image with the BEV image in the planned one by moving the couch in the X, Y and Z directions

Results: Data from 15 patients and 469 fractions of radiotherapy were analyzed in this study. Two sets of data were available from EPID software before and after 3D set-up corrections. The mean of the population displacement in Left /Right [L/R], Anterior/Posterior [A/P] and Crania/Caudal [C/C] directions were 0.5, -1.0 and 2.4mm before, and -0.1, -0.5 and 0.9mm after corrections, respectively. The systematic and random errors for the measured populations in the three mentioned directions were 2.4, 2.7 and 2mm and 6.4, 5.9 and 6.1mm before corrections, and 1.1, 2.4 and 1.4mm and 3.8, 3.9 and 3.6mm after corrections, correspondingly

Conclusion: This study provides further evidence that using gold markers in the prostate improves dose delivery to the prostate. Also, it has been demonstrated that the EPID can be a powerful tool in the reduction of treatment setup errors and the quality assurance and verification of complex treatments

[Relationship between religious orientation and spiritual health with emotional adjustment of the hospitalized adolescents]

Introduction: Spiritual health is important aspect of human health that provides integrated relationship between internal strengths. Spirituality and personal beliefs help individuals against problems and make their life meaningful. This study evaluated the relationship between spiritual health and religious orientation with emotional adjustment of admitted adolescents in hospitals

Methods: This cross-sectional study was conducted on 260 adolescents in hospitals of Arak University of Medical Sciences. The samples were selected by cluster sampling method. Data collection tools included three questionnaires: 1- Religious Orientation Scale, 2-spiritual well-being scale and 3-emotional adjustment scale. Data analyzed using SPSS-20 and with Pearson correlation test, Independent T-test, ANOVA and Multiple linear regressions

Results: Result of this study showed that between religious orientation and emotional adjustment there was no significant relationship [P>0.05]. But a significant relationship [P<0.0001] was found between spiritual health and emotional adjustment indicating adolescents with higher spiritual health had better emotional adjustment. The mean scores of emotional adjustment in males were significantly higher than females [p<0.004]. Age, marital status, education, ethnicity and religious ceremony were not correlated with emotional adjustment. Results of Multiple linear regression showed the score of spiritual health and gender predict%17.1 of adolescent emotional adjustment

Conclusions: In hospitalized adolescents, higher spiritual health was positively associated with increased emotional adjustment. Awareness of spiritual needs and encouraging usage of spiritual intervention and support by physicians and nurses is necessary in order to conduct a holistic care during treatment

[Benson muscle relaxation effect on patients anxiety undertake diagnostic and treatment within electrophysiological interventions]

Introduction: anxiety is a common psychological reaction in invasive diagnostic and therapeutic such as interventions electrophysiological, that requires nursing care management for assessment and application of effectiveness to reduce it

Objective: the present study has been conducted to determine the effect of Benson relaxation on anxiety in patients waiting for electrophysiological diagnostic and therapeutic interventions

Methods: this is a clinical trial study on 72 patients waiting for electrophysiological interventions, admitted in Heshmat Hospital - Rasht. Samples selected through convenience sampling method, and were allocated to intervention [usual care and relaxation] and control [usual care only] groups through Random Block method. Data were collected using the 2- part questionnaire include personal - clinical data and hospital anxiety and depression scale [only anxiety part] through interview and document records information. Data were gathered in 2 stages, first before 60-15 minutes and second 5-3 hours before electrophysiology intervention [personal-clinical characteristics and level of anxiety]. Intervention group encouraged to listen to audio instructions Benson relaxation for 10 minutes using headphones, and then exercise for at least 3 times between two steps of study. Data were analyzed by X2, paired t- test and independent t-test

Results: the results showed that the mean and standard deviation of anxiety score in the intervention group after the intervention has been much lower than before [3/11 +/- 3/43] compared to [7/91 +/- 6/70]. Paired t-test between the mean scores before and after relaxation in the intervention [P <0. 0001] and control group [P <0. 0001] was significant. Finally, independent test showed a significant difference [p<0. 0001] between the mean and standard deviation of anxiety score in the second step in two groups, which indicate the effect of relaxation on anxiety patients

Conclusion: according to the results of this study, Benson relaxation significantly reduced the anxiety level in these groups of study. Therefore nurses could use this method to reduce the level of anxiety in these patients

Frequency of the Accidental Contamination with Laboratory Samples in Yazd Clinical Laboratories personnel in 2011

laboratory personnel have always accidental exposure to clinical samples, which can cause the transmission of infection. This threat can be prevented and controlled by education for the use of safety instruments. The purpose was to determine the frequency of accidental exposure to laboratory samples among Yazd laboratory personnel in 2011. This descriptive cross-sectional study was conducted on 100 of Yazd clinical laboratory personnel. The data was collected, using a valid and reliable questioner, via interview and analyzed by means of SPSS software. Eighty-six percent of the subjects reported an experience of accidental exposure to clinical samples, such as blood, serum and urine. The causes were carelessness [41%] and work overload [29%]. Needle- stick was the most prevalent injury [52%] particularly in sampler workers [51%] and in their hands [69%]. There wasn't significant relationship between accidental exposure to laboratory samples and the variables such as private and governmental laboratories [p=0.517], kind of employment [p=0.411], record of services [p=0.439] and academic degree [p=0.454]. The subjects aged 20-29 [p=0.034] and worked in sampling unit had the highest accidental exposure. based on the results, inexperience of the personnel especially in sampling room, overload at work and ignorance of applying safety instruments are known as the most important reasons] for accidental exposure to clinical samples

[Effect of 8 weeks of aerobic training on serum level of visfatin and TNF- alpha in non-athletic young women]

There are controversial reports about the effect of training on serum level of visfatin and TNF- alpha Cytokine .This study was done to evaluate the effect of 8 weeks of aerobic training on serum level of visfatin and TNF- alpha in non-athletic young women. In this quasi-experimental study, thirty non-athletic healthy women were non-randomly based on the weight, height, BMI index and body fat percentage divided into two control and training groups. In the training group 8 weeks of aerobic exercise on a stationary bicycle 3 times a week was performed. Serum level of visfatin and TNF- alpha was measured using ELISA method, prior and at the end of 8th week of training while the subjects were fasted for 12-14 hours. At the end of 8 weeks of aerobic exercise, serum level of visfatin and TNF- alpha significantly reduced in the training group in comparison with controls [P<0.05]. Eight weeks of aerobic training reduces visfatin and TNF- alpha serum level in non-athletic healthy women

[ immediate effect of the rocker sole on postural stability in diabetic patients with neuropathy]

The effect of rocker soles on improvement of foot plantar pressure distribution is well documented. Rockers are commonly prescribed for diabetic patients with neuropathy in order to offloading the particular area of the foot sole thereby decreasing the chance of the foot ulcers. On the other hand, these patients may experience balance problems because of the somatosensory defects due to peripheral neuropathy. There is an evidence of postural destabilizing effect of rocker soles in healthy adults. The purpose of the current study was to investigate the postural responses to the rocker sole in diabetic patients with neuropathy. Seventeen diabetic patients with neuropathy participated in this study. Canvas shoes were modified by addition of toe only rocker soles made of EVA [Ethyl Vinyl Acetate]. The motor control test was conducted by the use of Neurocom system to evaluate postural stability with and without rocker sole. The Center of force displacement, response latency and response strength were measured. No significant difference was observed between the toe only rocker sole and without it in center of force displacement and response latency of the patients [P-0.05]. The results also indicated a significant increase in the response strength of patients by the rocker shoe, only in medium perturbations [P-0.05]. The results of this study demonstrated that the postural stability of diabetic patients with neuropathy in response to the toe only rocker shoe is the same as the shoe without any rocker profiles. However, rocker shoes increase the need for generating active force during the automatic postural response of these patients which may indicate a training effect on diabetic patients with neuropathy

[Validity and reliability of Persion version of home falls and accident screening tool in Iraniaian elderly]

One of the common problems in elderly people is falling. The effort to identify environmental risk factors at home and their modifications may control falls and injury in the elderly. Home FAST as a valid and reliable screening tool is used to identify elderly at risk of falling at home and in society. International quality of life assessment [IQOLA] was used for validity and reliability of Home fast. After forward and backward translation, the questionnaire was evaluated for content validity by 5 occupational therapists. Sixty participants aged over 65 were randomly selected through five geographical regions of Tehran. Inter-rater and test-retest with one week interval were conducted by two occupational therapists. Agreement among experts about the validity of screening tool of Home FAST [x[2]= 25.008] were more than 96%.The correlations of test-retest with relative and absolute coefficients were high [ICC = 0.72 and SEM = 0.89]. Also, the correlation coefficients between the raters with absolute and relative [ICC = 0.88 and SEM = 0.54] were significant, indicating the high reliability of this test. This study shows the reliability and validity of the test are high. Since, test items are conformable to fall prevention goals, these results can be expected. The tool can be used by professionals

[ effect of poron layered insole on ground reaction force in comparison with common insole on subjects with flexible flat foot]

Flexible flat foot is a congenital common deformity in lower extremity associated with ligamentus laxity. This deformity may cause hammer toe, heel spur, inflammation of achille tendon, early muscle fatigue during sport, foot imbalance and pain in leg, knee and hip. The use of insole with medial arch support considered as one of the common treatments for patients. The purpose of this study was to determine the effect of a composite insole, Ethy1 Viny1 Acetate [EVA] with Poron layer on ground reaction force on subjects with flexible flat foot in comparison with common EVA insole. Fifty two subjects [14 Male and 38 female] between 18-40 years of age with flexible flat foot participated in this study. Twenty six subjects received Poron insole [EVA with Poron layer] and 26 subjects received common EVA insole. After assessment each subject asked to walk with normal speed across two force plate in two conditions, walking with insole and shoe and walking without insole. Then each subject asked to use insole for forty hours during two weeks. Vertical ground reaction force in the first session and after two weeks was assessed. Impact force and first peak of vertical ground reaction force [F[1]] with Poron insole in comparison with shoe significantly increased in second session [P<0.05]. The second peak [F[3]] with common insole in comparison with shoe significantly increased in second session [P<0.05]. Significant reduction was noted in first peak [F1] with common insole in second session in comparison with first session [P<0.05]. There was no observable significant difference in two groups before and after intervention. The results of this preliminary study show that both insoles change vertical ground reaction force in comparison with shoe alone. But using a composite Poron Layer on EVA insole has not demonstrated a significant difference with common arch support insoles. Therefore application of Poron Silicon layer on EVA insole by itself can not show a significant reduction of ground reaction force

[ comparison among perspective of doctors, nurses and patients towards nursing advocacy role]

Patient advocacy is one of the most controversial issues in nursing during recent two decades. The purpose of this study was to determine perspective of doctors, nurses and patients towards the advocacy role of nurses about patients in hospitals affiliated to Shahid Beheshti University of Medical Sciences. This descriptive- comparative study was conducted on a sample of 329 doctors and 345 nurses and 225 patients, selected by a multi-stage sampling method. Data were collected using a demographic questionnaire and a Nursing-Advocacy-Perspective-Scale. The content and construct validity as well as internal consistency and test-retest reliability method were assessed and confirmed beforehand. The data was analyzed using SPSS 16 and statistical tests at the significant level of P<0.05. There was a significant difference among the three groups in average scores perspective [p<0/05]. Average scores of patients were higher than nurses and doctors, and nurses average scores were significantly higher than physician [p<0/05]. The nurse managers should promote the role of the facilitator and prevent loss of nursing advocacy and creating opportunities to provide this role in hospitals. In this regard the views of interest groups may help.

Evaluation of the effects of balance exercises on balance indices in, patients with diabetic neuropathy

Peripheral neuropathy is among the most common complications of diabetes. Balance deficit in diabetic patients with peripheral neuropathy is due to peripheral nerves injury. The purpose of this study was to investigate the effects of balance exercises on stability indices in diabetic patients with neuropathy. This clinical trial study was conducted on 10 diabetic patients with neuropathy as experimental group, and 10 healthy subjects with the same age as the control group. The subjects were recruited through simple nonprobablity sampling. Stability indecis of all subjects in the two groups were measured on bilateral and unilateral standing with open and closed eyes. Experimental groups were trained for ten sessions by progressive balance exercises and were examined again after the ten sessions. Then balance indices of the experimental group before and after training were compared with the healthy subjects. Overall and anterior- posterior stability indecis were significantly different before and after treatment in the experimental group during different conditions. These significant differences were betv/een 0.01 to 0.0001 for overall stability index with open eyes and antero-posterior index with closed eyes respectivly. Balance indices caused significant differences between the experimental and healthy subjects before the treatment [p<0.006]. After ten sessions of balance exercise therapy in the experimental group there was no significant differences in the indices between the two groups. Based on the results of this study, it can be concluded that balance training could improve stability indices in diabetic patients with neuropathy. The improvement is more significant in eyes open condition. Therefore balance exercise therapy is recommended for rehabilitation of diabetic patients with neuropathy

Comparison of the test-retest reliability of hip strength measurements using dynamometer fixed by hand versus fixed to a stable frame in female athletes

Assessment of hip strength needs a reliable method. Hand-held dynamometers are appropriate alternatives for manual muscle testing and isokinetics. Stabilizing the dynamometer with hand will increase error in measurements. The purpose of this study was to compare the test-retest reliability of hand-held dynamometer fixed by hand and fixed to a new stable frame for measuring hip extension, abduction and external rotation strength in healthy female athletes. Normalized average and peak values of torque of three successive trials for each muscle group were calculated in two sessions one week apart in ten healthy female athletes. Strength was measured with hand-held dynamometer fixed by hand and fixed to the stable frame in each session. Intra-class correlation coefficients [ICC], coefficients of variation [CV] and standard error of measurement [SEM] were calculated to determine the reliability. For hip extension, abduction, and external rotation strength measured by hand fixation. The ICC ranged from -1.22 to 0.6, the CV ranged from 8% to 33% and the SEM ranged from 0.007 to 0.04. For strength measurements with stable frame, the ICC ranged from .93 to .96, and CV ranged from 5.26% to 7.94%. The range of the SEM was from .004 to .08. Measurements of hip muscles strength with a dynamometer fixed to a stable frame showed higher reliability than fixation by hand in young female athletes. These findings support the error within hand fixation of dynamometers and the necessity for providing better fixation

Temporal stability of torque parameters and induced perception following muscle fatigue

Muscular fatigue is common problem that an athlete faces repeatedly during sport competition or therapeutic exercise. Undoubtedly, fatigue affects the precision of subjects' performance and limits the range of physical and sport activities. Muscle fatigue advantages and disadvantages have been reviewed in many previous studies. To challenge this controversy fatigue evaluation requires reliable, stable and precise methods of analysis itself. Researches on muscle strength and subject's perception of fatigue have been done in many studies. Therefore; researchers in this study focus on temporal stability of both subjective perception of fatigue and produced muscle torque after fatigue. Fifteen healthy female between 20-30 years of age, who at least had some non-professional light sporting activities once a week, volunteered in this research. Each of volunteers was evaluated in 3 different sessions. The first session was to familiarize the volunteers with the Isokinetic tests. For the main test, each of the volunteers was evaluated once and then after one week interval. At each session after warm up, perceived fatigue was measured using Visual Analog Scale. Then Average peak torque and average power maximal concentric Isokinetic of quadriceps were measured at the velocity of 60 degrees per second. To perform the fatigue protocol, subjects were asked to perform successive maximal quadriceps contractions until the three subsequent quadriceps torque output drop below 50 percent of maximal torque output. Afterwards, for re-measurement average peak torque, average power and perceived fatigue were evaluated similarly. The interaclass correlation coefficient [ICC] of average peak torque, average power and visual analog scale before performing fatigue protocol were calculated%81.6,%87.4 and%47.9 respectively. The repeated ICC after fatigue has estimated%59.9 >%64.4 and%96.6 respectively. This research demonstrated that Isokinetic temporal stability parameters were high before fatigue. In other words, both torque and power are reliable in two repetition times in a session, as well after one week interval between. After fatigue; the stability rate of torque and power recorded by Isokinetic were repeatable and this repeatability has been moderate to high. However; VAS showed a completely opposite results, in which before fatigue the stability of imagined local fatigue perception has been very low and was not significant, although after fatigue the VAS showed high repeatability

Reliability and minimal detectable change of foot arch height index device

This study was aimed to examine the reliability of a developed device measuring [arch height ratio] index. 40 feet [the right and left foot of 20 subjects] were measured. Foot length was measured from posterior aspect of calcaneus to the tip of longest toe and dorsum height was measured at the midpoint of total foot length. All measurements were assessed in three weight bearing conditions of 10, 50 and 90 percent of total body weight on three occasions [10 minutes and five days after the first measurement] by a single rater. Finally the arch height ratio index was calculated. The ICC values in different conditions of 10, 50 and 90 percent of total body weight in 10 minutes after the first measurement were calculated 0.96, 0.97 and 0.92 and in five days after the first measurement were calculated 0.97, 0.97 and 0.91. Minimal detectable change values of arch height ratio index in all conditions of measurement were 0.01. Simplicity of usage, low cost and high reliability of this device is highly recommended for clinical and research use

Capabilities assessing of teaching hospitals in Iran University of Medical Sciences in attracting medical tourists according to JCI patient-oriented standards

Medical tourism is an increasing industry that patients travel to abroad for receiving health care services. The countries which are successful in this industry have global accrediting quality. This research is aimed to access capabilities of selected hospitals in Iran University of Medical Sciences in attracting medical tourists according to JCI patient-oriented standards. This research is a descriptive, cross-sectional study that carried out in Hasheminejad, Rajaie and Motahhari hospitals. To collect data patient-oriented checklist of JCI standard used. Data analyzed by using descriptive statistic techniques. The results showed the high rates of consideration is related to medication management and standards used [84/5%], and anesthesia and surgical care standards [80%] that both of them are related to Hasheminejad hospital and also patient and family rights standards [47/5%] are low rates of considerations that are related to Motahhari hospital. Generally, the mean rates of consideration in Hasheminejad [71/8%] are more than Rajaie hospital [67%] and these hospitals are more than Motahhari hospital [62/3%]. Generally, the selected hospitals had rather readiness and possible and appropriate capabilities in attracting medical tourists. Some standards [access to care and continuity of care, patient and family education, assessment of patients, anesthesia and surgical care] were appropriate and some of them were insufficient [patient and family rights, care of patients and patient and family education]. According to identify strengths and weaknesses of the hospitals in medical tourism, they could use SWOT analytical model to increase their capabilities

[Assesing the result of exercise test on the patients with typical and atypical chest pain referring to the Mazandaran Cardiac Center in 2007]

The main signs of cardiac disease [particularly the coronary disease] was chest pain and the shortness of breath. ETT is a prognostic and diagnostic tool for assessing the ischemic heart patients. The aim of present study was to determine the results of applicating ETT for patients with typical and atypical chest pain complaints referring to the Mazandaran Cardiac Center 2007. This descriptive study was conducted on 500 patients with typical and non Typical pain referring to the heart centers of Mazandaran province. After the interview, examination and laboratory tests, attended by the researcher and cardiologist, the patients under went ETT [Exercise Tolerance Test] with Tread mill according to Bruce protocol [Bruce Protocol] in four steps. The present study showed the positive effect of exercise test in 80[16%] of cases. The positive test results of exercise test in the cases with typical heart pain was 25 times more than the cases with atypical heart pain. 43[53.75%] of the cases with positive test were male the majority of whom were [41caseses,51.25%] in age range of 51-65 years. 12.5% of cases with positive test and also 78.6% with negative test had atypical pain. getting serious signs and symptoms of various disease serious [especially of the typical and atypical chest pain] is among the main educational priorities for the prevention of cardiac infarction

Quality of drinking water consumed in interurban bus transportation system ofkerman in the first half of 2008

Promoting the hygiene and health level of the society would not be achieved while there is no pure source of potable water. A suitable and healthy drinking water should bear both a good chemical quality and a hygienic condition. The running water of the pipelines network is free from microbial infections due to free chlorine residue. In some cases, while transferring water from one container to another, there is the risk of pollution because of the conditions that are out of control. One of these cases is the water consumed in interurban transportation bus system. If this water is contaminated, there would be the risk of getting infected by water borne diseases. This study was performed to find out the quality of water consumed in the public bus transportation systems ofKerman in the first half of 2008. This is a cross-sectional study including 84 samples. We evaluated and assessed total coliform, fecal coliform, turbidity, free chlorine, pH and temperature. The collected data were analyzed by MINITAB. The results revealed total coliform in%45 of samples, positive fecal coliform in%35, turbidity 3MTU in% 42.5, 4MTU in% 46.25 and 5MTU in 11.25. The amount of free chlorine residue among%73.75 samples was zero. Temperature and pH ranged between 10-19 C and 7-8 C. In general, the microbial quality of the water consumed in the buses was recognized as unhygienic. The results of this study are consistent with similar studies performed in Kermanshah 1996, Isfahan 2004, Bandar Abbass 2004, and Mashhad 2006.The results achieved in this study showed a higher rate of pollution in total coliform than the similar rates in other cities. The index rate of total coliform in Kermanshah was higher than the one in Kerman. The rate of pollution related to fecal coliform in the consuming water of buses in Kerman was lower than the ones in Kermanshah and Mashhad and higher than the ones in Isfahan and Bandar Abbass

[Assessing unmarried students' marital criteria in Mazandaran university of medical sciences]

Marriage is one of the effective factors in the mental health and individuals life styles which its role in reducing personal and social disruptions has been acknowledged. In order to plan properly and increase youth's awareness of right marital criteria, get to know their viewpoint is necessary. The study aimed at assessing single students' marital criteria in Mazandaran University of Medical Sciences, 2006. Using descriptive- analytic study method, 380 unmarried male and female students were 'selected through systematic random sampling. The data were collected using a questionnaire consisting demographic characteristics and marriage criteria, on a 3-point rating scale from very important, till important to some extent. All statistics were computed by the SPSS software data, using chi-square test. Most of the participants were female, ranging in age from 18 to 23 years. The students, mostly [46.7%] were studying in 1-4[th] semesters. In general, the participant had positive attitude to marriage. Variables like age, sex and level of education were significantly correlated with spouse selection criteria like mutual understanding, faithfulness, beauty and attractiveness, parents' agreements, love, education similarities, having same religion, having same taste, and not having heritable disease in the family. The study revealed the valuable criteria for the male students as mutual understanding, faithfulness, being responsible, beauty and attractiveness and knowing each other before marriage. The valuable criteria for female student were mutual understanding, faithfulness, parent's agreement, knowing each other before marriage, love, being responsible, beauty and attractiveness. Youth marriage should be facilitated by providing financial supports and more protection, knowing their viewpoints

Molecular pathology of 6 novel GJB2 allelic variants detected in familial and sporadic Iranian non syndromic hearing loss cases

Mutations of GJB2 gene encoding connexion 26 are the most common cause of hearing loss in many populations. A very wide spectrum of GJB2 gene mutations associated with hearing loss have been detected but pathogenic role has been tested only for a part of them. In this study, we have provided genetic evidence on the pathogenicity of our previously reported novel GJB2 allelic variants. The pathogenic role of GJB2 allelic variants were assessed using co segregation of each allelic variant with hearing loss in family members, absence of the allelic variants in control populations, coexistence with a second GJB2 mutation, nature of the amino acid substitution and evolutionary conservation of the appropriate amino acid. The GJB2 allelic variants including 363delC, 327delGGinsA, H16R and G200R have been co segregated with autosomal recessive non syndromic hearing loss in five families and are not found in control subjects. The G130V and K102Q were found in heterozygous state in two deaf individuals. G130V results in an exchange a residue highly conserved among all the connexins but was found with a rate of 1% in control subjects and K102Q results in an exchange a residue not conserved among all the connexins and not identified in control subjects. We conclude that, 363delC, 327delGGinsA, H16R and G200R may be pathogenic. However, the pathogenicity and inheritance of K102Q and G130V can not be assessed clearly and remains to be identified

Refractory status epilepticus in children; risk factors, management and early outcome

Refractory status epilepticus is a life-threatening disease in children wherein seizure movements don't response to first line anti convulsion drugs. This study reviewed risk factors, management and early outcome of children with refractory status epilepticus. Patients with refractory status epilepticus admitted in Tabriz children's hospital between 2003 and 2006 were reviewed prospectively for risk factors, management and outcome at time of discharge from hospital. Of the total of 121 patients with status epilepticus, 47 patients [38.8%] were afflicted with refractory status epilepticus. The most common form of refractory status epilepticus was acute symptomatic [38.3%]. Seizure caused by acute symptomatic [RR= 2.36, [CI 95%= 1.25 - 4.44], P=0.006] was a risk factor for refractory status epilepticus development. 87.2% of patients with refractory status epilepticus were treated by midazolam infusion. There was no significant relation between non-response to midazolam, etiology [P=0.798] and type of seizure [P=0.273]. Early outcome of children with refractory status epilepticus was significantly worse than those with status epilepticus [P=0.0001]. About 38% of patients with status epilepticus develop refractory status epilepticus with an increased mortality and morbidity. Seizure caused by acute symptomatic is an important risk factor for developing refractory status epilepticus. In most cases, midazolam infusion results in end of seizure

[Patient satisfaction with emergency departments]

Patient satisfaction is an important indicator of quality of care and service delivery. The objective of this study was to examine patients' satisfaction with the emergency departments in hospitals affiliated to Tehran University of Medical Sciences. A study was carried out in the emergency departments of five major teaching hospitals [affiliated to Tehran University of Medical Sciences] in Tehran, Iran by trained researchers using a valid and reliable questionnaire. The study included patients who had spent at least 10 hours in the emergency department, who were able to answer the questions without the need for an interpreter, did not have significant cognitive problems, and were well enough to answer the questions. The study questionnaire comprised five sections namely: nursing care, physician care, behavioral concerns, physical comfort and hoteling, and waiting time. The questionnaire was administered in secure and confidential conditions inside the emergency department and in the absence of the hospitals' medical and non-medical staff. Data were analyzed descriptively using SPSS 13. In all 153 patients were eternal into the study. After dichotomizing the state of satisfaction in each of the five dimensions, the highest dissatisfaction rates were observed in the following domains: nurses' explanation to patients [73.2%], giving information [54.2%], investigating complaints [40.6%], patient welfare facilities [54.3%], and being kept waiting to receive laboratory services [26.2%] respectively. Only 44% of the patients rated their general satisfaction with the hospital as good or very good. The findings indicate the need for measures to improve services for patients visiting the emergency department and to ensure quality of service