[Identifying factors associated with length of hospital stay using decision tree]

Introduction: one of the main factors of hospital costs resulting in hospital resources constraints is Length of Stay [LOS]. Recognizing factors associated with this index can result in optimized utilization of resources and reducing LOS. The present study has been conducted with the aim of investigating LOS-related factors using decision tree applied on hospital admission data

Methods: in this descriptive-retrospective study, 188068 patient data were extracted from computerized patient records including 16 variables in all wards in Ghaem Hospital in Mashhad, Iran, during 2009-2014. After data cleaning, in order to determine the factors associated with LOS, statistical procedures including univariate analysis, chi-Square statistical test, one-way ANOVA, and CHAID algorithm were applied on our data using SPSS Statistical Software version 19

Results: the mean and median of LOS in Ghaem hospital were 6. 5 and 4 days, respectively. Out of 15 independent variables entered the model, 11 variables including the ward, the patient's age, the admission reason, the doctor, the referral status, the patient's job, the marital status, the status of the residential place, the caregiver[s], admission day of the week, and the insurance type were associated with LOS

Conclusion: the results of data mining techniques can be different based on the input data. Therefore, to identify the factors related to LOS, it is necessary to enter the related data of individual hospitals into the model and to use the obtained results at the same hospital

[Scaphoid fractures: a comparison of two surgical methods for internal fixation using either Herbert screws or multiple pins]

Scaphoid fractures are the most common fractures of the wrist. This study compared the outcomes of two surgical internal fixation techniques, using either Herbert screws [HS group] or multiple pins [MP group], in the treatment of scaphoid fractures. This cross-sectional study was performed on 41 patients [23 in HS and 18 in MP groups] with unilateral scaphoid fractures from September 2009 to September 2011. All patients were followed-up two weeks post-surgery, every month for six months, and then every year after one year. Degree of fracture healing, measured level of pain using Visual Analog Scale [VAS], range of motion, hand grip strength of affected limb vs. healthy limb, Quick DASH score [QD] and also Mayo Modified Wrist Score [MMWS] were recorded. In December 2012, all patients presented to the Orthopedic Clinic for their final follow-up visit where all data was recorded once more. Mean patient follow-up time was 24.34 +/- 8.70 months [range: 11-34]. Mean scaphoid fracture healing times for the HS and MP group were 14.61 +/- 3.88 and 14.39 +/- 4.27 weeks, respectively. No statistically significant difference was found between both groups after comparing mean levels of pain using VAS, ROM of wrist during flexion and extension, hand grip strength expressed as percentage of normal, QD, and MMWS. The level of patients' content using VAS was 9.5 for HS and 9.0 for MP groups. The use of multiple pins for the internal fixation of scaphoid fractures proves to be a viable treatment option compared to Herbert Screws, due to decreased cost and increased availability

[Relationship between assertiveness and critical thinking in nursing students]

Assertiveness and critical thinking help improve the academic practice of nursing students. Therefore, the aim of this study was to determine the relationship between assertiveness and critical thinking in nursing students. This analytical and correlation study was performed on 213 nursing students in Tehran University of Medical Sciences using convenient sampling. Main study tools were California critical thinking skills test [CCTST] and assertiveness inventory of Gambril and Richi. Data were analyzed by SPSS 16 software using ANOVA, chi square and Pearson correlation coefficient test. Mean scores of assertiveness and critical thinking for nursing students were 68.15 +/- 12.79 and 9.32 +/- 3.38. Many students had moderate level of assertiveness [89.7%] and most of them had unusual level of critical thinking [94.8%]. Pearson correlation coefficient test showed a direct correlation between assertiveness and critical thinking [r=0.045] with no significant difference between the two variables [P=0.51]. It is necessary to revise the teaching strategy to improve the level of critical thinking in nursing curriculum. To achieve assertiveness training in nurses, efforts should be made to identifying and support nursing students who have low levels of critical thinking

gabapentin effective on pain management after ar-throscopic anterior cruciate ligament reconstruction? a triple blinded randomized controlled trial

Acute pain is common after arthroscopic surgeries and it is one of the most important causes of patient dissatisfaction, admission time and increased morbidity, Gabapentin with anti-hyperalgesic effects can play a critical role in pre-emptive analgesia methods. The aim of this study was to assess the efficacy of gabapentin in pain management after surgery and the rate of drug consumption in patients who are candidate for anterior cruciate ligament [ACL] reconstruction arthroscopic surgery. In this randomized, triple blind clinical trial, 114 patients who were candidate for arthroscopic ACL reconstruction were divided into two groups of gabapentin [G] and placebo [p], with 57 patients in each group. The intervention group received gabapentin 600 mg and a placebo was administered in control group. Patients received on-demand pethedine for pain management. The primary outcome was pain intensity according to the visual analogue scale [VAS] and the secondary outcome was the amount of opioid consumption and incidence of side effects [including: dizziness, sedation, nausea and vomiting] at 6 and 24 h visits. The mean pain intensity in G group at both the 6 and 24 hour visits was significantly lower than the control group [Both p<0.0001]. Also, patients in the gabapentin group consumed less opioid at both visits in comparison to the placebo group [p<0.001, p=0.032]. The incidence rate of sedation, dizziness, nausea and vomiting was similar in both groups. In arthroscopic ACL reconstruction, administering a preoperative single dose of 600mg gabapentin may decrease both pain intensity and opioid consumption

[Incidence of neural tube defects and its risk factors in Yasuj, Iran [2000-10]]

The incidence of neural tube defects [NTDs] is varied according to race, geographical situation and other predisposing factors. This study was carried out to determine the incidence rate of NTDs and its risk factors in Yasuj, Iran. This case - control study was done on live newborns in Imam Sajad hospital, Yasuj, Iran during 2000-10. 78 neonates with NTDs out of 36755 live newborns were considered as cases. The control group was also consisting of the same number of healthy neonates who born at the same period and in the same hospital. Data were collected by a check-list and analyzed using SPSS-19, Chi-Square, Logistic regression and odd's ratio. The incidence rate of NTDs was 2.12 per 1000 live births. Anencephaly and Spina Bifida was detected in 59 [75.6%] and 19 [24.3%] of affected newborns, respectively. The ratio of females to males was 1.5 times. 53.85% of mothers with affected newborns were grouped in 27-36 years age range. The mean number of pregnancies and abortion between two groups of mothers had no statistical significant differences. There is no significant relation between the mothers occupation and the incidence of NTDs. 10 [12.8%] of mothers from case group and 7 [8.97%] of mothers from control group have used tobacco. 52 [66.7%] of mothers of case group and 30 [38.5%] of controls did not consumed folic acid. The relation between non-user folic acid during pregnancy with NTDs was significant [95% CI: 1.4-6.15, OR=2.93, P<0.001]. This study showed relatively high incidence of NTDs in Yasuj. Non-consuming folic acid increased the risk of NTD by 2.93 times

[Mental health status of nursing staff]

Mental health disorders are common problems among helping professionals such as nurses that create many psychosocial problems. This study aims to determine the mental health status of nursing staff. it was a descriptive, cross-sectional study .All of nursing personnel [n=92] in Fateme Zahra hospital in Najafabad city were recruited by census .Data was collected by The Symptom Checklist-90-R [SCL-90] and analyzed by descriptive statistics, t-test and ANOVA using SPSS-PC [v. 11.5]. The finding showed that%81.1 of nurses was healthy and 18.9% of them were exposed to mental disorders .The most prevalent disorders were: 7.3% somatic disorders, 5.8% paranoid thoughts and%5 anxieties. According to the findings, more attention should be paid to mental health of nursing staff to improve quality care and to retain nurses

Serum level of matrix metalloproteinase-3 in patients with oral Lichen planus

Oral Lichen planus [OLP] is a chronic lesion of the oral mucosa with unknown origin. Basement membrane changes are common in OLP and may be mediated by proteases such as matrix metalloproteinase [MMPs] and mast cell chymase. The aim of our study was to evaluate the level of serum MMP-3 in OLP compared to normal individuals and assess its clinical significance. Thirty four serum samples from patients diagnosed with OLP [12 males, 22 females, age: 42.2 +/- 10.8 years] and 34 serum samples from healthy control subjects [11 males, 23 females, age: 42.5 +/- 13.3 years] were collected and MMP-3 concentration was measured by ELISA. The serum MMP-3 level in OLP patients was higher [21.64 +/- 24.31 ng/ml] compared with healthy controls [16.52 +/- 23.63 ng/ml], but showed no statistically significant difference. A statistically significant difference was demonstrated between the two types of OLP, being more pronounced in the erosive/atrophic form 6]. The different clinical appearances of OLP are associated with significant differences in MMP-3 serum level

[Effects of iron and vitamin E on thickness of carotid artery wall of hyper cholesterolemic rabbits]

Cardiovascular diseases are the main cause of morbidity and mortality in the developed countries. One of the indices of vascular injuries in atherosclerosis is proliferation and migration of smooth muscles of tunica media of arteries with lipids peroxidation by endothelial cells causing an increase in thickness of arterial wall. It is distinguished that iron can reduce antioxidant levels indirectly and also has a major effect in LDL per oxidation. As there is still doubt about anti-oxidative role of vitamin E in atherosclerosis formation, in this study, we observed the effect of vitamin E and iron on the thickness of the media of the carotid artery of hypercholestrolemic male rabbits. Thirty white male rabbits were fed with cholesterol, Iron and Vitamin E for 42 days, and then these groups, and the carotid arteries were dissected. The samples were fixed in 10% formalin, and after tissue processing, serial sections were obtained, and H and E staining was done. Morphometrical studies were done by Motic Plus 2 and light microscope. Statistical analyses were conducted with SPSS software and ANOVA test. Intima-media thickness of arterial wall in those received iron and cholesterol, was significantly increased [p<0.05], but in the group receiving Vitamin E and cholesterol, this size was reduced [p<0.05]. According to our findings, Vitamin E due to its anti-oxidative effects on free radicals, was found to prevent arterial wall thickness, and thus has a protective role during atherosclerosis

[Evaluation of correlative factor of backache and headache after spinal anesthesia in orthopedic surgery]

Spinal Anesthesia [S.A] is currently becoming a more common and popular method for orthopedic surgeries. Unfortunately, Backache [BA] and Post Dural Puncture Headache [PDPH] are both frequent and troublesome. Several factors [including needle shape and size, frequency rates of puncture attempts, and age and gender] have been shown to affect the rates of such complications. To determine these factors and evaluate some modalities to prevent them. This is a prospective study on 200 patients- 15 to 65 years old with class type 1 and 2 A.S.A [American Society of Anesthesiology], who were candidates for orthopedic lower extremity surgeries. Anesthetic procedure was performed using a standard 24G needle L idocaine 5% plus Epinephrine. Symptom questionnaire was filled for the history of Headache and Backache and history of former S.A. postop puncture complications of 1[st] day, 1[st] week and 1[st] month were added to the forms. Statistical analysis was performed using SPSS version 16 and the results were considered significant at p<0.05. Rates of BA and PDPH were 12.5% and 17%, respectively. Post anesthetic BA for first day, week, and month were 16%, 9%, and 3.5%, respectively and PDPH were 6.5%, 3.5% and 1% respectively with no significant differences. History of former spinal anesthesia with BA and PDPH revealed notable differences [p<0.001]. The results of this study support the idea that history of previous spinal anesthesia could be a triggering factor for backache and headache in prior Spinal anesthetic procedures

[Poland syndrome and association with atrial septal defect and pulmonary stenosis; a two case report]

Congenital unilateral absence of pectoralis muscles in combination with ipsilateral brachysyndactyly is the most acceptable definition of Poland syndrome. This very rare syndrome has been reported in association with various malignancies and deformities including cardiovascular anomalies. To our knowledge, pulmonary stenosis associated with Poland's syndrome has not been described previously in literature, and there are a few articles about atrial septal defect [ASD] in combination with this syndrome either. We present the first report of Poland syndrome associated with pulmonary valve stenosis and another case of Poland syndrome with ASD. We discuss common etiologic factors of this rare syndrome. Case one: The first patient is a 23 month old boy with Poland syndrome presentation such as absence of pectoralis major of right hemi-thorax, nipple and subcutaneous hypoplasia and ipsilateral brachysyndactyly. On physical examination, we found a systolic ejection sound in auscultation so that a complete cardiac evaluation was performed. Pulmonary stenosis with 7[mm] diameter was detected by Color-Doppler echocardiography. The second patient is a 5 year old girl presenting typical Poland syndrome clinical manifestation. She has congenital right pectoralis major agenesis, Right upper position of nipple and areola was compared to left hemi-thorax, and an ipsilateral hypoplastic hand with syndactyly and short fingers. The 2-dimentional echocardiogram revealed that she is suffering from an Ostium Secundum ASD. Although Poland syndrome is a rare congenital one, it is associated with numerous anomalies and malignancies in the reported articles. The two mentioned cases are the samples of cardiac anomalies associated with this very unique syndrome. According to critical situation of cardiovascular problems, performing a complete cardiovascular evaluation in addition to common medical-surgical treatments seems to be essential for patients with Poland syndrome

[ effect of assertiveness on postpartum depression]

Postpartum depression endangers mother's health and has negative effect on her social communication and infant development. Assertiveness is a part of life skills that improve depression. Therefore, this study was done aiming at determining the effect of assertiveness on postpartum depression. This Study was a semi-experimental, witch was accomplished in Fateme Zahra hospital in Najafabad. 60 samples were selected from mothers with 4-8 weeks after delivery through convenience method and then divided into 2groups randomly. Case group intervention was accomplished. Depression in both groups before and 1 month after intervention was measured by Beck questionnaire. The obtained data were analyzed by statistical tests, paired- T, independent T, X2 and P

Survey of aflatoxins in kashkineh: a traditional Iranian food

Aflatoxins are mycotoxins produced by Aspergillus flavus and Aspergillus parasiticus that can contaminate human and animal foods, including corn, wheat, rice, peanuts, and many other crops resulting in the illness or death of human and animal consumers. The aim of this study was to detect aflatoxin Bl, B2, Gl, G2 and total aflatoxin in Kashkineh, a traditional Iranian food. This survey was conducted to detect aflatoxins on 41 samples of Kashkineh. The samples were randomly collected from traditional bazaars and supermarkets of Khorramabad city of Iran. The presence and quantity of aflatoxins was determined by high performance liquid chromatography [HPLC]. The average concentrations of AFB1, AFB2, AFG1, and AFG2 hi all samples and in a mixed sample of all samples were not detectable [ND]. The only sample that showed aflatoxin contamination was sample number 29 of which the AFB1 concentration was 0.64 ng/g. Although some people believe Kashkineh is carcinogenic due to toxins, this study showed kashkineh is not contaminated with aflatoxins

[Perceived social support among hospital personnel and its influential factors: a case study]

Increasing productivity in an organization requires providing various conditions; important of all is human factor. Social support is known as a psychological factor in workplace that effect on productivity of human factor. The purpose of this study is to determine the rate of perceived social support among hospital personnel. In order to do this research 120 of employees of a selected hospital in Isfahan were surveyed using a self-report questionnaire. A convenience sampling method was used to select the samples. The questionnaire measured demographic information of employees and their perceived social support by coworkers and managers. The questionnaire was validated using the experts' judgment. A Chi-Square test was used to test the relationship between the demographic information and the perceived social support. The findings indicated that the employees' perceived social support by coworkers [with the mean of 3.34 +/- 0/48 on scale of 1-5] was higher than the perceived social support by managers [with mean of 3.19 +/- 0.4]. The Chi -Square test also showed a significant relationship between perceived social support and age and work experience of the employees [p<0.01]. The employees perceived social support by managers is not at the ideal level in the investigated hospital and for increasing the productivity level in this organization it is necessary that managers to take new policies under consideration. Meanwhile establishing a stronger relationship with employees can potentially increase the employees' efficiency

assessment of the mental health condition of the nursing personnel and the factors affecting it

Mental health disorders are common problems that occur among the hospital staff like nurses at a high rate. It causes multiple mental and social problems for the patients in long term. The aim of this study is to determine the level of mental health in the nursing staff and the factors affecting it. This is a descriptive and analytical research. This is a cross-sectional study in which all the nursing staff [92 cases] of one hospital were studied. Data was collected by a demographic questionnaire and SCL-90 test and then it was analyzed. Data was analyzed by descriptive statistics, t-test and ANOVA. Results showed that 81.1% of the nurses were healthy and 18.9% of them were exposed to mental disorders. The most common disorders were: 7.3% somatic disorders, 5.8% Paranoid ideation and%5 Anxiety. According to these findings, hospital managers must pay more attention to the mental health of their nursing personnel to take steps toward improving the quality of health care

[Functional outcomes of radial nerve palsy associated with humeral fractures using microscopic nerve repair procedures]

Radial Nerve Palsy [RNP] is the most common nerve lesion complicating humeral shaft fractures in 2%-17% of cases. Exploration timing [early or delayed] and various nerve repair procedures are still matter of dispute. The objective of this study is to determine the functional treatment outcome of microsurgeric repair of RNP associated with humeral fractures. In this retrospective study of 20 patients [15 males and 5 females with a mean age of 35 +/- 12.5] with humeral fractures, 15 cases had primary RNP and t he other 5 cases experienced nerve palsy after their orthopedic manipulations [secondary or iatrogenic RNP]. Of the first 15 patients, 7 cases had open humeral fractures which were treated using ORIF and early exploration procedures and 8 cases with closed humeral fractures treated conservatively with closed reductioncasting and delayed exploration after 3months because of no recovery. Iatrogenic RNP were observed for 3 months and explored after no sign of recovery. Nerve repair procedures were performed based on nerve injury and patients were followed up for a mean of 24.4 +/- 2.5 months [19-20 months]. Exploration findings, kind of nerve repair and functional recovery rate [based on Alnot criteria] were recorded and analyzed using SPSS-19 software. Of the 7 cases who suffered from total radial nerve transection [repaired by interfasicular grafting] 3 cases had good outcome, 2 cases had fair outcome and 2 cases were failed. Exploration of 3 cases revealed partial nerve tearing [repaired by neurorrhaph y] with good results. Eight cases with perineural fibrosis and 2 cases of nerve entrapment in callus were treated by interfasicular neurolysis and the results were good. Overall recovery rate of these three procedures was 90%. In patients with RNP associated with humeral fractures, choosing proper microsurgeric nerve repair and determining proper exploration timing [early or delayed] could result in desirable functional outcomes

[Comparison the method of wrist supination with elbow flexion as classical method with hyperpronation method in reduction of radial head subluxation in less than 7 years old children]

The radial head subluxation is a common cause in less than 7 years old children who refered to emergency center after pulling of their wrist by parents. Compare the method of wrist supination with elbow flexion as classical method with hyperpronation method in reduction of radial head subluxation [pulled elbow] in children less than 7 years old referig to poorsina hospital during 2004-2009. In this randomized clinical trial, children who had referred to Poursina orthopedic emergency center with clinical diagnosis of radial head subluxation were studied consequent. Patients were randomly treated as consequent male and female with one of two methods. The patients were checked in order to diagnosis extremity functions return every 5 minutes. If extremity function had not returned, the primary method was repeated after 15 minutes. Unsuccessful treatment led to treatment with another method 30 minutes after first try. That method repeated if replacing method was not successful after 15 minutes. If both methods were unsuccessful, elbow radiography to roll-out other injury was performed. After collecting data, analysis was performed using chi- square test and T- test with SPSS software version 16. Among 110 patients were included in this study with average age [4.05 +/- 1.51 years] 58 patients [3.91 +/- 1.41 years] with first method [SF] and 52 patients [4.21 +/- 1.62 years] with second method were treated. [P=0.31]%62.7 of patients were male and the remaining were female [%37.3]. In 47 patients [%90.4] of 52 patients who were treated by [HP] method. This was 46 patients [%79.3] from 58[P=0.11]. Five patients of [HP] group needed second attempt where as this number were 12 about [F] group. Treatment with [HP] method was successful in 100 percent patients, but successful rate was%87.9 for [SP] method. There was significant superiority of [HP] success in comparison to [SF] [P+0/006]. In reduction of radial head subluxation [HP] method was more successful upination method in reduction of radial head, it is more successful than supination, when supination was not successful than [SF] method

[Designing of human cartilage tissue, by differentiation of adipose-derived stem cells with BMP-6 in alginate scaffold]

In the present study the effect of BMP-6 was investigated on chondrogenesis of adipose-derived stem cells. Mesenchymal stem cells derived from subcutaneous adipose tissue were cultured on alginate scaffold to induce chondrogenesis in experimental group, with chondrogenic medium having BMP-6 growth factor for 3weeks. In control group medium without BMP-6 was applied. The harvested constructs were examined with immunohistochemical and RT-PCR methods for assessment of cartilage-specific characteristics. The results of immunohistochemical method revealed the presence of typical cartilage extracellular matrix components such as type II collagen and aggrecan in constructs induced by BMP-6 growth factor on alginate scaffold. In addition evaluation of the results of RT-PCR analysis confirmed the expression of cartilage- specific genes, such as type II collagen and aggrecan, in the differentiated cells under the influence of growth factor BMP-6. It can be concluded that BMP-6 promotes chondrogenesis of ADSC in 3-D and adipose-derived stem cells could be used for cartilage tissue engineering

[Infant under 1-59 month mortality causes in Zabol]

Infant less than five years mortality is one of developing health index in countries. In recent years under five years mortality rates has been decreased in our country but still is higher than the developed countries. Thus we prompted to investigate some causes in infant under 1-59 month mortality during 2006. This is a descriptive study which conducted during 2006.In this study 93 cases were selected using census sampling. Data collected by Infant mortality registering checklists that confirmed by Health and treatment service ministry of Iran. These checklists filled by educated critics' personnel. Researcher et al exploited data by analysis in registered checklists then converted data to digital form and analyzed by SPSS software. Finding showed that 93 deaths occurred. The most frequency of them related to 1-12 months age [57%] that 37% of cases were female and 63% of them were male. Majority causes from death is collisions and accidents [27%]. Mortality from respiratory diseases was 18/3 percent and gastrointestinal diseases 15/2 percent. Majority failure in treatment causes is Insensibility in parent due to treatment [76%] and insistence of parent to discharge their infant from hospital because they were so impecunious to paid treatment costs [12%]. Our finding showed that Infant mortality rate in this city was higher than country rate which has various reasons that one of these reasons was rise in collisions rate. Thus it is essential to perform implementations to reduce collisions rate as well as it essential to perform effective implementation for maternal and newborn care, infant and newborn nutrition's, vaccination

Report of four cases of rhinocerebral mucormycosis in Loghman hospital in 1388

Rhinocerebral mucormycosis is an aggressive fungal disease that involves the nose, paranasal sinuses, orbit and central nervous system. It may rapidly be fatal. This infection usually occurs secondary to immune suppression, diabetic ketoacidosis, and prolonged use of antibiotics, steroids, and cytotoxic drugs. Management of the condition consists of treatment of the underlying disease and surgical debridement combined with intravenous amphotericin-B. We presented 4 cases of rhinocerebral mucormycosis with same presentation. They presented with coryza, erythema and swelling of periorbital area several days before admission. Symptoms progressed quickly and ptosis and chemosis developed. Paranasal CT scan showed opacification in ethmoid, frontal and maxillary sinuses. Diagnostic endoscope showed necrosis in orbit and nasal root. Orbital exenteration, necrotic tissue debridment was done. Smear of necrotic tissue showed branching nonseptated mycelium in favor of mucoral. Culture of necrotis tissue showed rhizopus. Amphotericin-B started for all the patients. Two patients expired in spit of extensive surgical debridment and medical therapy and two survived. The diagnosis of rhinocerebral mucormycosis should be considered in the clinical setting of necrotic sinusitis and acute neurologic deficit in diabetic patients. Early diagnosis and treatment are crucial factors leading to a good outcome