[ concept analysis of critical thinking in clinical nursing]

Background and Aim: Aging of population, increased cultural and social differences in societies, increased rate of chronic diseases, reduction of financial resources, the flash-like technological changes, emphasis on home care, increased trend toward patient-centered care and evidence based practice have resulted in more complexity in clinical environments. Providing standard safe and effective care in such environmental conditions can only be achieved by development of critical thinking skills in the nursing staff. There are many definitions about critical thinking in nursing. Many of these explanations are complicated, without significant relation to the clinical and professional performances

Material and Methods: We used eight step Rodgers' concept analysis method to provide a clear definition about critical thinking in clinical nursing to determine antecedents, attributes and consequences. We searched valid online data bases for in English and Persian articles from 1995 to 2014. Finally, 58 articles 3 dissertations and 2 chapters from two books were analyzed by means of Rodger's inductive approach

Results: The results of this study showed that, critical thinking in clinical nursing have 3 antecedents and 6 attributes including Use of nursing process in clinical situation, emphasizing on holistic and comprehensive performances, Use of different patterns in order to achieve understanding, Using emotional intelligence skills in predisposing clinical situations, predisposing factors for critical thinking and elements of critical thinking. Achievement of critical thinking leads to positive outcomes such as effective and patient-centered care, creativity, evidence based practice and professionalism

Conclusions: The result of this study let to development of a clear and comprehensive definition of critical thinking in clinical nursing. This definition can correct many misconceptions and misuses of the concept of critical thinking. The findings also can help clinical nurses to create a framework and guidelines for effective clinical performance. This framework can, guarantee the competency in nursing

[Data requirement and appropriated structure for diabetes progress note]

Introduction: Currently, the world faces the serious problem of chronic diseases. These diseases need on going care more than treatment. For care to be recognized as a principle, it should be standard, recordable and evaluable. This requires specific data to beenteredin a system with the appropriate framework. This study aims to determine data requirements and appropriate structure for a template that documents diabetes. Materials and Methods: This was a descriptive cross-sectional study performed in 2013-2014. A checklist containing 18 groups of diabetes data elements was prepared through studying the inpatient and outpatient diabetes records, as well as related research studies. The check list was presented to and evaluated by a focus group consisting 8 experts. An score was calculated for each of the data elements according to the item influence index formula. Results: Using the item influence index formula, of a total of 99 data elements, 73 were approved and 26 were rejected. Data were classified based on the Subjective, Objective, Assessment, Plan [SOAP] method. Conclusion: As the approved data requirements were derived from a focus group containing endocrinologists, health information management and medical informatics experts, and classified based on the standards of SOAP, it is expected that the approved data and structure be an appropriate tool for diabetes data collection and acceptable to its users

[ effect of orientation tour with angiography procedure on anxiety and satisfaction of patients undergoing coronary angiography]

Recently, coronary angiography has become the largest interventional diagnostic test in cardiac patients worldwide having large effects on anxiety and satisfaction of patients in treatment and care. This study aimed to study the effect of orientation tour on anxiety and satisfaction of patient candidates for coronary angiography procedures. In this randomized control trial study, 148 patients were recruited by random allocation. Patients were divided into two groups with block randomization. Patients in Intervention group, in addition to routine training, orientation tour in the angiography unit was taken too. Anxiety was measured in all patients during admission, before surgery and discharge time; the satisfaction was measured in discharge time too. Collection instruments were according to demographic data, Spielberger state trait anxiety inventory and the Visual Analogue Scale. The Information was obtained by t-test, chi-square and repeated measured were analyzed by SPSS. After the orientation tour, anxiety scores significantly in the intervention group [39.5] compared with the control group [48.26] which decreased [P<0.001]. Anxiety scores at discharge decreased in the intervention group [33.24] compared with the control group [41.22] which was significant [P<0.001]. The mean patient satisfaction score at discharge in the intervention group [9.77] compared to control group [6.11] was statistically significance [P<0.001]. Orientation tour in patient candidates to angiography, reduces anxiety and increases satisfaction, therefore, use of this educational approach in patients undergoing coronary angiography is recommended

[Decision making process and related factors in adolescents with premenstrual syndrome]

Decision making for adopting a health behavior is a process involving passing through different stages. This study was conducted to determine the decision making stages based on Precaution Adoption Process Model [PAPM] in female students with premenstrual syndrome [PMS]. In this quasi-experimental within-subjects study, the PAPM stages were assessed in 317 high school students with PMS, who were exposed to an educational intervention based on PMS concepts. Decision making stages before and after the educational intervention were assessed based on PAPM. All the participants in pretest assessment were at the stage 0 of decision making. None of them had changed her decision making stage during a one-week posttest assessment. After exposure to educational intervention, about 10.1% were assessed as stage two, 26.8% were in stage three, 1.9% reached stage four, and 61.2% were at stage five. In a regression model, PMS scores could predict 2% of variance in decision making stages. PMS severity and sign interference with social and school performance had a significant correlation with the individual's decision making stage [p < 0.05]. Adolescent girls with PMS are not in the same stage of decision making after exposure to educational intervention and obtaining the necessary knowledge about PMS. Based on this finding, the design of educational interventions for PMS students must be stage-based. Perceived severity of PMS symptoms and PMS sign interference with school and social activities are among the variables that can be considered as PAPM constructs

effects of the counseling on life style of menopausal women and their husbands

By increasing the life expectancy, women experience longer menopause and more complications during this period of life. Men may also experience menopause. Improvement and treating the complications is based on the correcting the life style. The purpose of this study was to evaluate the effect of a counseling procedure on the life style of menopausal women and their husbands.This was an interventional study. 120 couples of menopausal women and their husbands were selected from Mohammadiyeh medical health center in Hamadan participated in the study. The participants were randomly divided to control and interventional groups. Initially, life style information was collected by a questionnaire through interview. Counseling about nutritional habits and physical exercise was performed for one hour in participants' houses. After two months there was first post test. Another counseling session and post test was performed similar to first one. Data was analyzed by Me Nemar, Paired T test, Wilcoxon, Independent T test and Chi- square tests, using SPSS 13. Results showed a significant difference in items such as food habits and physical activities of life style, before and after of first and secondary counseling process in women and men in intervention groups [P<0.05]. Counseling has significant effects on nutritional habits and physical activities of the menopausal women and their husbands. Counseling with couples particularly in their houses, is an effective intervention for improving of participants' life style

[Using asymmetric mixed bivariate modeling for comparing diabetic macular edema treatments according to visual acuity and central macular thickness outcomes]

One of the major causes of visual acuity loss in diabetic patients is diabetic macular edema [DME]. Best-corrected visual acuity and central macular thickness changes are considered as two main outcomes in diabetic macular patients. The goal of this study was to compare the effect of intravitreal bevacizumab injection alone or combined with triamcinolone versus macular photocoagulation as primary treatment for diabetic macular edema according to the clinical trial data sets. A new method was proposed to determine the best treatment for DME; i.e. intravitreal bevacizumab injection alone or combined with triamcinolone versus macular photocoagulation using asymmetric mixed modeling based on the recorded data in 97 diabetic patients. Effect of these treatments was investigated according to simultaneous investigation of visual acuity and central macular thickness as two major outcomes without omitting any outlier. The results of bivariate asymmetric mixed model revealed that intravitreal bevacizumab injection alone or combined with Triamcinolone treatments had more therapeutic effect than the macular photocoagulation in terms of increasing visual acuity and decreasing central macular thickness in patients with DME. Using asymmetric bivariate mixed model, there was a significant difference among the treatment modalities, duration of diabetes and gender in terms of visual acuity and central macular thickness

[Change-point in poisson distribution with application in Iranian mortality data]

Changing the pattern of mortality gives important perspective of health determinants. The aim of this study is to detect location and time of mortality pattern change in country using statistical change point method during 1971-2009 Years. We assume for years before and after K0, Y1 has a Poisson distribution with meansand lamda[0] and lamda[1] respectively. We used several methods for estimation change point in real data by assume Poisson model. Using two simulated and real data analysis showed that the change point has been occurred in year 1993 and this confirmed by all methods. Our findings have shown that the change pattern of mortality trend in Iran is related to improvement of health indicators and decreasing mortality rate in Iran

Application of artificial neural network in predicting the survival rate of gastric cancer patients

The aim of this study was to predict the survival rate of Iranian gastric cancer patients using the Cox proportional hazard and artificial neural network models as well as comparing the ability of these approaches in predicting the survival of these patients. In this historical cohort study, the data gathered from 436 registered gastric cancer patients who have had surgery between 2002 and 2007 at the Taleghani Hospital [a referral center for gastrointestinal cancers], Tehran, Iran, to predict the survival time using Cox proportional hazard and artificial neural network techniques. The estimated one-year, two-year, three-year, four-year and five-year survival rates of the patients were 77.9%, 53.1%, 40.8%, 32.0%, and 17.4%, respectively. The Cox regression analysis revealed that the age at diagnosis, high-risk behaviors, extent of wall penetration, distant metastasis and tumor stage were significantly associated with the survival rate of the patients. The true prediction of neural network was 83.1%, and for Cox regression model, 75.0%. The present study shows that neural network model is a more powerful statistical tool in predicting the survival rate of the gastric cancer patients compared to Cox proportional hazard regression model. Therefore, this model recommended for the predicting the survival rate of these patients

relationship between obesity and quality of life in school children

To determine relationships between healths related quality of life and body mass index in children aged 9-11 years old. This cross sectional study was conducted on 240 children 9-11 year olds who were selected via multi stage cluster sampling design from primary schools in the Shahre Qods of the Tehran, Iran in 2007. Pediatric Quality of Life inventory was completed by child self report with measured height and weight used to determine body mass index percentile/weight classification. Obesity was defined as body mass index [BMI] >/=95[th] percentile for age and gender and one way analyses of variance [ANOVA] was used for data analyses. Physical, social and school functioning was significantly lowered for obese when compared to normal weight children [P<.05]. The impairment in QOL in the community-based sample of elementary school children was less marked than clinical sample of obese. Obese children maintain emotional health. These results highlight the importance in considering dimensions of quality of life at further understanding obesity in children

[ effect of family-centered empowerment model on the quality of life of school-age asthma children]

Asthma is a common disease in children and decrease asthmatic child's quality of life and has main effects on family function.The nurse's roles to increase their quality of life. Thus, the purpose of this study is to investigate effect of family-centered empowerment model on asthma school-age children's quality of life. This is a Quasi-experimental study with cluster random sampling. 7 elementary schools from one of the 19 Tehran's areas selected randomly and these schools divided randomly into case group [4 schools] and control group [3 schools]. The data gathering tools was consisted of demographic information questionnaire and general Peds QoL and asthma Peds QoL questionnaire of child. Validity and reliability were done. Group discussion, demonstration and educational participation were used for empowered children and their parents.the questionnaires were filled by children and their parents in pre and post test. These were no significant difference before the intervention between the two cases and control groups in terms of demographic characteristics and Qol of children. While, independent t-test showed a significant difference between the two groups means of the general and asthma Peds Qol before and after the intervention. Also, the paired t-test showed a significant difference before and after the intervention in the case group in terms of the general and asthma Peds Qol [P<0.0001]. This study shows the effect of family-centered empowerment model on asthma school-age childrens quality of life and it is suggested that such a model be implemented on other age groups and in much more study population

[Artificial neural network design for modeling of mixed bivariate outcomes in medical research data]

Mixed outcomes arise when, in a multivariate model, response variables measured on different scales such as binary and continuous. Artificial neural networks [ANN] can be used for modeling in situations where classic models have restricted application when some of their assumptions are not met. In this paper, we propose a method based on ANNs for modeling mixed binary and continuous outcomes. Univariate and bivariate models were evaluated based on two different sets of simulated data. The scaled conjugate gradient [SCG] algorithm was used for optimization. To end the algorithm and finding optimum number of iteration and learning coefficient, mean squared error [MSE] was computed. Predictive accuracy rate criterion was employed for selection of appropriate model. We also used our model in medical data for joint prediction of metabolic syndrome [binary] and HOMA-IR [continues] in Tehran Lipid and Glucose Study [TLGS]. The codes were written in R 2.9.0 and MATLAB 7.6. The predictive accuracy for univariate and bivariate models based on simulated dataset I, where two outcomes associated with a common covariate, were shown to be approximately similar. However, in simulated dataset ?? in which two outcomes associated with different covariates, predictive accuracy in bivariate models were seen to be larger than that of univariate models. It is indicated that the predictive accuracy gain is higher in bivariate model, when the outcomes share a different set of covariates with higher level of correlation between the outcomes

[Investigation of influential factors affecting survival rate of patients with colorectal cancer using copula function]

Competing risk data is one of the multivarite survival data. Competing risk data can be modelled using copula function. In this study we propose a bayesian modelling approach of competing risk data using the copula function. We used the data from colorectal cancer registyrarty in Tehran. After constructing likelihood function using Clayton copula by choosing appropriate prior distribution for parameters, we obtained the posterior distribution of parameters using the Metropolis-Hastings algorithms and Slice sampling. The results of univariate analysis showed that sex, histology of tumor, extent of wall penetration, lymph node metastasis, distant metastasis and pathological stage of tumor were significantly associated with colon cancer and sex, histology of tumor, lymph node metastasis, distant metastasis and pathological stage of tumor were were significantly related to rectal cancer. In the multivariate analysis, age at diagnosis, tumor grade and distant metastasis were significant prognostic factors for colon cancer and tumor grade and size of the tumor were significant prognostic factors of rectal cancerAs we showed some variables may have different impacts on colon and rectum cancers, consequently, further studies are needed to be conducted considering risk factors of these cancers separately

[Effect of some risk factors associated with intrauterine growth retardation [IUGR]]

Intrauterine Growth Retardation [IUGR] is defined as approximate weight of embryo being less than the ten percentile. Some of the factors contributing to the IUGR are as follow: The mother history of chronic diseases, the mothers BMI, the trends of mother weight gain at the time of pregnancy, the mother's age at the time of pregnancy, the mothers job, various embryonic infections, placenta and uterine disorder. This cross-sectional, descriptive-analytical study was performed on pregnant women referring to the prenatal clinic of Baghiyatollah hospital at the years of 2009 and 2010 .Fifty hundred four pregnant women, between the age of 18 and 35 years were examined as available, these following variable were surveyed: The mothers age at the time of delivery, the mothers BMI at early pregnancy, the mothers weight gain during pregnancy, the mother history of chronic diseases, the age of pregnancy, the mothers job and education, blood group and RH, gravid, the interval of deliveries, gender of newborn with IUGR. Data was analyzed by SPSS, chi-square and the logistic regression model. 60.3% had normal BMI, 29.2% had BMI higher than normal, and 10.5% had BMI lower than normal. 50% had normal weight gain, 31.7% had weight gain higher than normal, 13.1% had weight again lower than normal, 10.3% had a chronic disease, 15.1% were employed and 83.3%of women were educated. There was a significant relationship among the mothers BMI at the beginning of pregnancy, the rate of mothers weight again during pregnancy, the mothers history of chronic disease, the mothers job and the newborns gender with IUGR. Probability of IUGR is higher in woman whose weight gain was lower than normal rang, female newborn and housekeeper mothers. There is a direct link between IUGR and the history of chronic disease in mothers

[Applying segmented regression model to analysis the trend of tuberculosis incidence rate in Iran between 1964 -2008]

Study trend of observed rates changes provide valuable information for need assessment, plan, reload programs and develop indicators of each country. The main objective of this paper is to determine the changes in tuberculosis incidence rate trend in Iran by applying segmented regression model. In this study, segmented Linear Regression employed to analyze the trend of changes in pattern of Tuberculosis incidence rate during past 44 years [1964-2008] in Iran. We used least square method and permutation test and Bayesian Information Criteria to decide which of the two segment regression model and poison regression would be better. Data analyzed by Joinpoint 3.4 and SAS 9.1 software. According the permutation test, it was detected that there were two breakpoints over 1977 and 1993 years [p=0.0108]. Incidence rate of tuberculosis during the first 11 years of review had declined with annual percentage change = -10.1%, for second segment it rose upward with 4.3% increase in per year and for end segment TB incidence rate again declined with annually 4.5%. The average annual change of Tuberculosis incidence rate in Iran for at least 10 years has been estimated -4.5 percentages. The findings of this study have shown that the incidence rate of Tuberculosis decreased after 1992 that interestingly this decline seems faster than estimated by international TB control program. This indicates that preventive and treatment of Tuberculosis programs have been successful in Iran

[Epidemiology of tuberculosis in Iran [2001-08]]

The characterization of any disease have important role for the evaluation and control strategy and programming of diseases. This study was done to determine the epidemiology of Tuberculosis in Iran during 2001-08. In this descriptive cross sectional study, Annual percentage change [APC], average annual percentage change [AAPC] of Tuberculosis incidence rate, mortality of Tuberculosis, case detection rate, success percentage in Tuberculosis treatment and relapses cases during 2001-08 have been studied in Iran. Linear segmented regression model was used for analysis trend of Tuberculosis and estimate parameters. The trend of Tuberculosis smear positive [SP] incidence rate was reduced in Iran during 2001-08. Anually, 4.1% and 3.6% reduction took place in incidence rate and relapses cases, respectively. Tuberculosis mortality decreased annually by 6.8% and success in case detection increased by 2.5%. The Tuberculosis treatment though AAPC is decreasing by 0.5%. The trend of Tuberculosis are higher among women and in both sexes over 65 years of age. This study showed that trend of SP pulmonary tuberculosis and treatment success rate is decreased, but case detection was increased

Comparison of artificial neural network and binary logistic regression for determination of impaired glucose tolerance/diabetes

Models based on an artificial neural network [the multilayer perceptron] and binary logistic regression were compared in their ability to differentiate between disease-free subjects and those with impaired glucose tolerance or diabetes mellitus diagnosed by fasting plasma glucose. Demographic, anthropometric and clinical data were collected from 7222 participants aged 30-88 years in the Tehran Lipid and Glucose Study. The kappa statistics were 0.229 and 0.218 and the area under the ROC curves were 0.760 and 0.770 for the logistic regression and perceptron respectively. There was no performance difference between models based on logistic regression and an artificial neural network for differentiating impaired glucose tolerance/diabetes patients from disease-free patients

[Nurses' readiness in research utilization: moving toward evidence-based practice]

Research utilization is a mechanism for transferring the results of research into practice and improving the quality of care in nursing. The aim of this study was to determine nurses' readiness to utilize research needed for applying evidence-based practice. In this descriptive study, 375 nurses in all teaching hospitals affiliated with Tehran University of Medical Sciences were selected by stratified random sampling method. A 4-part questionnaire with open and close-ended questions including professional profile, research activities, research skills and access to research resources was used for data collection. Content as well as face validities and Cronbach's alpha for reliability [0.82] were identified. 85.9% of nurses had weak readiness in research utilization. Both research activities and skills were also low [71.4% and 82.7% respectively]. 44% of nurses had insufficient access to research resources. A significant relationship was found between nurses' educational level, participation in research activities as well as English language skills and their readiness in research utilization. Lack of skills and inaccessibility to research findings lead to weak readiness for research utilization. With respect to the importance of utilizing research findings, organizational and administrative support, continuing education programs, well-defined processes and pathways to facilitate research utilization need to be provided for nurses

[Effect of physical activity on depression in obese women]

Depression is a mood disorder that is considered as a world epidemic problem. The prevalence of depression among women is twice of men. It accompanies some complications such as immobility and obesity. Literature shows women are at greater risk of obesity and consequent depression which both contribute in worsening women's physical, emotional and health problems. Physical activities are ways to reduce depression. Conducing the present study which aimed to determine effect of physical activity on depression in obese women in Iran is therefore necessary. A quasi-experimental study was conducted. 222 depressed and obese women, referred to healthcare centers located in zone 17 of Tehran for their healthcare issues were recruited to the study. They were randomly allocated to two groups of intervention and control after being diagnosed by Beck standard questionnaire. Intervention group had physical activities as study intervention. The effects of physical activities were assessed before and after the intervention in both groups. All statistics were computed by the SPSS software, using Pearson, Chi-square, Kolmogrov - Smirnov and Mann Whitney tests. The study demonstrated that after exercise, 70.1% of samples had reached to normal level. Depression level of obese women in intervention and control groups were found to be significantly different [P=0.001, NNT=2]. The study showed that doing exercise was effective in reducing the level of depression in women and the number of women in need of treatment and prevention of bad outcome was two persons. So the study recommends including excersice to daily plans of Iranian women. This is a key point for adding exercise program to Iranian women daily activity living. All organization who have health affairs need to consider the correlation between life style and mental health as part of mental health plans for the society in order to present the complication of depression

[Assessing food habits for cancer prevention among Tehran citizens]

Cancer is one of the three health issues of the society and the third cause of mortality in Iran. Food habits play a significant role in preventing cancer. The present study therefore, was carried out to assess food habits of Tehran citizens for cancer prevention. This study is a cross- sectional study was conducted with a sample of 2500 Tehran citizens who were recruited through systematic cluster random sampling. Data were collected using questionnaires including demographic factors and food habits. Validity and reliability of tool was gained through content validity and Alfa-Cronbach test. Data was collected in one time occasion and in person. All statistics were computed by the SPSS software using descriptive and inferential tests. The showed demonstrated that the 38.2% of Tehran citizens had their BMI at the level of being overweight and upper. The food habits for cancer prevention were relatively appropriate for most of them [61.3%], but no one was at the desired level. Concerning the study results that no one had proper food habits for cancer prevention, public education and increasing awareness of people in this regards by ministry of health, cancer institutes, mass media, educational system, ministry of labour and social affairs is strongly recommended

[Reasons for using withdrawal contraception: a qualitative study]

To identify reasons why married women use withdrawal when they do not desire pregnancy. This was a qualitative study. We performed 50 interviews with women who were using withdrawal contraception. Theory of Planned Behavior used as framework for elicitation salient believes about contraception methods. Participants were married women who were not currently pregnant, not desire to have a child, using withdrawal contraception. Women gave many reasons for using withdrawal contraception. Three major categories emerged: behavioral believes, normative believes and control believes. The results suggest that multidimensional interventions may be needed to effectively reduce withdrawal contraception and unwanted pregnancy