Prevalence of inflammatory bowel disease among patients with primary sclerosing cholangitis in Iran

Background and study aims: In Iran, the epidemiology of primary sclerosing cholangitis [PSC] and its association with inflammatory bowel disease [IBD] have not been studied thoroughly. This study investigates the epidemiology and prevalence of IBD among patients with PSC

Patients and methods: A retrospective study of 154 patients with PSC was conducted. The demographic and clinical data were collected, and the variables were analysed in the following two patient groups: patients with both PSC and IBD, and patients with PSC and without IBD

Results: A total of 154 patients with a mean age of 40.3 years [range 20-81 years] were included, of whom 57 [37%] were female and 97 [63%] male. Ninety-six patients [62.3%] were diagnosed with IBD, 92 [59.7%] with ulcerative colitis, and four [2.6%] with Crohn's disease. In this study, elevated alkaline phosphatase levels were found in 90.8% of patients. The intra-hepatic duct [IHD] and extrahepatic duct [EHD] were involved in 70.5% of patients, isolated intrahepatic bile duct in 24.4%, and isolated extrahepatic duct in 3.8%. Small-duct PSC [normal results of imaging and PSC proved by histology of liver biopsy] was observed only in 1.3% of patients

Conclusion: PSC has become increasingly diagnosed in Iran. This is possibly because of better diagnostics and the increasing prevalence of IBD in this country. For diagnosing PSC and identifying the presence of IHD strictures, the results of both magnetic resonance cholangiopancreatography [MRCP] and endoscopic retrograde cholangiopancreatography [ERCP] showed good interobserver agreement, but the ERCP results could be used to evaluate the presence and severity of EHD strictures

Vickers hardness of composite resins cured with LED and QTH units

Statement of Problem: One of the factors affecting the degree of polymerization of light-cured composites is the type of light-curing unit used. In addition, physicomechanical properties of the composite resins depend on the degree of conversion and polymerization

Objectives: Since the type of initiator in new composite resins is not explained by manufacturers, this study is an attempt to compare the depth of hardening, with two LED and QTH light-curing units

Materials and Methods: Fifteen samples prepared from Gradia Direct and Filtek Z250, both of which being universal, were cured with QTH [Astralis 7] and LED [Bluephase C8] light-curing units. All the samples were molded in polyester resin and cut from the middle by a disk. The hardness of the cut area was evaluated at 0, 0.5, 1, 1.5, 2, 2.5, 3, 3.5 and 4-mm depth intervals and also at the same interval as the width of the sample, with Vickers hardness machine, while the samples were placed in a darkroom. Data were statistically analyzed using one-way ANOVA, two-way ANOVA, t-test and post Hoc Tukey's tests in SPSS, version 16

Results: Filtek Z250 was harder than Gradia Direct at all the depth with both light-curing units. The hardness of Filtek Z250 sample cured with Astralis 7 was higher than that cured with LED, but with Gradia Direct the LED unit resulted in higher hardness. Curing depth was not significantly different between the groups [p = 0.109]

Conclusions: Vickers hardness number for both composites used in this study is in an acceptable range for clinical implications. The composites' composition is important to be considered for selection of light unit. Based on the findings of the present study, LED did not present more curing depth compared with QTH

[Empowerment of nurses drug calculations]

Introduction: To safely prescribe medication in clinic, drug calculation ability is one of the basic skills that nurses must have. The major cause of medication errors is wrong dose calculation prescribed by nurses. This study aims to enhance the drug calculation ability of nurses of Hazrate Fatemeh Zahra hospital of Najaf Abad

Method: It was a quasi-experimental approach in which questionnaire was used to collect data. The population was nurses working in Hazrate Fatemeh Zahra hospital of Najaf Abad. Sampling method was convenience sampling. First, by using a researcher made questionnaire, pre-test was conducted from 43 people of the population. Then, intervention was done through workshops and after three weeks, the post-test was done. Reliability determined by using internal consistency and by split-half reliability and calculating Spearman-Brown reliability coefficient was 0.93. Data analysed with SPSS statistical software version 18 and statistical tests such as independent t-test, sign, Wilcoxon, Mann-Whitney, McNemar and Pearson's correlation coefficient was performed

Results: Out of the 43 nurses participating in the study, 21 nurses [48.8%] were at the intermediate level before training and after training all the nurses [n=43, 100%] were at the advanced level and answered at least 83% of the questions correctly. Before performing drug calculations course, the mean score of female nurses was 14.52 and the mean score of male nurses was 18.93 and the total mean score of nurses was 15.93. In the beginning, there was a significant difference between the scores of male and female nurses [P<0.05] and male nurses had higher total drug calculation score. After taking the course, the mean scores of female nurses increased to 23.03 and male nurses to 23.29 and the total mean score of nurses to 23.12, and a significant difference between the scores of the nurses in the sample and in both males and females in the drug calculation test before and after the course was observed [P<0.05]

Conclusion: The results of this study indicate an increase in drug calculation abilities of nurses based on their score improvement in drug calculation in written test which was performed before and after intervention. According to the findings, the need for nurses in drug calculations was clear and by planned and ongoing training, these skills that are sensitive in preventing medication errors can be increased. Considering the importance of the issue and the reduced mastery of drug calculations that has been observed, it is suggested that these programs continue in different working periods of nurses so that they would be effective

[Concept of the quality of the educational services in cardiac rehabilitation]

Achieving quality educational services is one of the current health system challenges; and nurses have a great role in this regard. Although quality educational services are a complex concept; so it is important to clarifying and exploring the related components. The study aimed to describe the components underlies to quality educational service in a cardiac rehabilitation program qualitatively and introduce some of the related problems. This is a qualitative study using qualitative content analysis method.Study population consisted of health practitioners working at health and research centers affiliated to Isfahan University of Medical Sciences, cardiac patients including inpatient and out patient service users and their assistants [family members]. Data were gathered through conducting unstructured interviews with a purposive sample of 25[consisted of 3 physicians, 6 nurses, 1 dietarian, 13 patients and 2 patient assistant]. The study was begun at 1386 and data analysis was completed at 1388. The rigor of the study was achieved applying Guba and Lincoln directions. The concept of quality educational services in cardiac rehabilitation is described using four underlying concepts namely fittingness, comprehensiveness, authenticity and orderliness that are the elements of quality educational services in the cardiac rehabilitation program. Based on the findings, paying attention to audiences' special needs and capabilities are important determinants in providing quality educational services in the cardiac rehabilitation program. Hereby the audiences could receive the trustful and responsive services. We suggest organizing the education and information giving routs. It would result in service comprehensiveness that could save the service taking opportunities. The existed problems were inadequate fittingness, poor coordination in the services and poor referral system that were resulted in poor response to some of the audiences needs. [Quality educational services] is a context based concept. Considering the cardiac rehabilitation, it was emphasized on providing need based services fitted to users' capabilities, attending to various bio-psycho-social aspects at both person and family levels and serving the services through predefined and coordinated pathways. It is necessary to nurses as one of the key members of cardiac rehabilitation team that consider such emerged elements in service management and direct care delivery to the cardiac patients and their families. Future researches on emerged concepts are worthy to suggest

Extra-adrenal pheochromocytoma arising from an accessory adrenal

Reported here is a case of pheochromocytoma arising from an accessory adrenal gland. This tumor did not have significant clinical symptoms related to pheochromocytoma. The chief complaint was intermittent left upper quadrant pain. Scintigraphy of the abdomen identified normal bilateral adrenal glands, and a 56×63 mm tumor, adjacent the distal part of pancreas. The resected tumor was located between pancreas and spleen and was composed of normal adrenalortical tissue and pheochromocytoma. Immunohistoche-mical staining of tumor for KI67, chromogranin A, NSE, S100 and AE1 was positive. Pheochromocytomas, arising from an accessory adrenal gland, may lack some of the typical characteristics of such tumors and have rarely been reported

[Evaluation of the effect of local dexamethasone injection to reduce inter appointment pain in endodontics treatment]

Inflammation is one of the factors causing pain and also the focus of attention of the researchers. Dexamethasone has been mainly used for many years, for its potent anti inflammatory effect and minimal side effect. To a considerably great extent it has been effective in reducing pain. The aim of this study was to determine the effect of local dexamethasone injection to reduce inter appointment pain in endodontic treatment. The nature of this study was randomized controlled single blind trial. It was conducted on 60 patient [men and women] who needed endodontic treatment, on either single of multiple teeth, vital or non vital, maxillary or mandibular and needing multiple appointments. Information needed was got after the injection of 2ml dexamethasone or ringers solution in the buccal vestibule of the involved tooth of questions about personnel demographics, quality and quantity of pain, use and non use of analgesics were asked and the reply collected and analyzed using the software EPI X2 and t-test exam. Results of this study, about the rate of frequency of pain, severity of pain, average degree of pain in the two groups, case and witness at 4 hrs, 8 hrs, 24 hrs and 48 hrs after treatment showed statistical significance. Also comparing on the basis of the analgesics used, adverse effects of the injection, sex, condition of the pulp, vital or non vital, presence or absence of radiolucency at the apex. Significant statistical difference was found in the two groups after treatment. Considering this results, use of local dexamethasone injection at the end of the appointment, causes reduced pain and inflammation in the periapical region of the tooth

[In- vitro evaluation of apical microleakage using three different root- end filling materials]

Periapical surgery has been performed to remove irritant factors and seal the end of the root. So, selection of retrograde filling materials which can produce hermetic seal and are easily available with reasonable prices seem to be necessary. The aim of this in-vitro study was to compare the sealing ability of Pro Root MTA, Root- MTA and Portland cement. In this experimental in-vitro study, 40 intact mandibular first premolar teeth were selected and cut from the site of cemento-enamel junction [CEJ]. The canals were prepared using step back method and obturated with Gutta-percha and sealer by lateral condensation technique. The 3 mm of the apical portion of the roots were cut with a 45 angle to the long axis of the teeth. Thirty six teeth were divided into three experimental groups and the 4 remaining teeth were considered as control groups. Cavities randomly with 3 mm depth were prepared in the apical of the canals by a 1/2 round bar, and in the experimental groups they were filled with pro-root MTA, root MTA and/or Portland cement. The surfaces of the roots were covered by nail polish. After incubations, the teeth were kept in%2 methylen blue solution for 24 hours. Then, the teeth were cut longitudinally and the depth of color penetration were evaluated by a stereo microscope. The data were analyzed using one-way ANOVA and Mann-Whitney U test. In the positive control group, the dye had penetrated the total cavity; in the negative control group, microleakage was not found. There was no significant differences between the Pro Root MTA and Root MTA [p>0.05],but Pro Root MTA and Root MTA had significant differences with Portland cement [p<0.05]. Pro-root MTA had the lowest apical microleakage followed by root MTA and Portland cement respectively. Considering the results of this study, Portland cement cannot be replaced with Pro-root MTA in retrograde fillings, but using Root MTA as a substitute for Pro Root MTA needs more investigations

[Types and major causes of conflicts experienced by nurses: a qualitative analysis]

Background and Objective: conflicts among health care personnel including nursing personnel who require extensive interaction with different people, is common and almost inevitable. As there is not sufficient information about the causes, types, and dimensions of interpersonal conflicts among clinical nurses and the adverse effects of these conflicts on the function of nursing team in Iran, we aimed to perform this study in order to find out causes of different inter-group or inter personal conflicts among nurses using qualitative research method and Grounded Theory Approach [GT]

Materials and Methods: the data was collected through interviews. Constant comparison method was used in order to perform qualitative analysis

Results: open coding process resulted in emergence of causal conditions and different types of conflicts within the nursing society. Exposure to imposed conditions, confronting with opposition, disagreement and destructive behaviors were indicative of characteristics of conflicting events and tasks, process, relational and marginal conflicts which were major categories of conflict in clinical settings. Feeling threats towards benefits was recognized as the main apprehension of participants. This core variable can explain how conflicts occur and develop within nursing society according to conflicts of benefits

Conclusion: the findings showed that individual factors and intra as well as extra-organizational factors were major and/or contextual causes of inter-group conflicts among nurses. One of the significant and interesting findings in this study was that the conflicts did not affect the occupational function of nurses despite the significant effect on marginal issues in their work environment. The study also showed that these conflicts are part of simulation process in nursing tasks

[Challenges of nursing students during their study: a qualitative study]

Several studies have recommended revisions in educational programs based on learners' feedbacks and needs. This study was performed with the aim of exploring and describing the meaning of challenges and feelings experienced by nursing students during their study. This qualitative study was performed as phenomenology on 20 senior nursing students selected by purposeful sampling method. In-depth and semi-structured interviews were used for data gathering. Data was analyzed by the team of researchers using hermeneutic analysis method. Findings were categorized into three major themes including challenge of "integrating knowledge and practice" with minor themes of employing theory in practice, using nursing procedure, and following scientific principles in clinic, the challenge of "management of learning environment" with the minor themes of environmental factors' effect on students' learning, causes of hopelessness and disappointment with nurses, preference in evaluation, deficiencies of educational programming, and lack of respecting patients' rights and privileges, and the challenge of "lack of community's respect to the value of nursing" with the minor themes including recognizing stAuts of nursing discipline, and the necessity for its revision, attitude of individuals and society toward nursing and limited independence of nursing. Interviewing students provided an insight into the challenges of educational environment which students had faced, during their study. Using the results of this study, nursing educators could build a positive and stimulating environment for students' learning and motivate them to maintain their interest in education and learning

[Nursing students' experiences and perceptions of effective instructor in clinical education]

Clinical education program was designed to promote nursing education which its processes are mainly aimed at students. Despite all of this, less attention has been paid to students' feedback in this process. This study focused on nursing students' personal experiences about instructors' roles in clinical education program and intended to clarify the concept of "effective instructor" in clinical education. Using purposeful sampling method, 12 nursing students of Isfahan University of Medical Sciences, who had passed at least one clinical education course, were selected and studied through phenomenological approach. Data was gathered through in-depth interview. Raw data was analyzed using Colaizzi method. The validity and reliability of the study was acquired through considering four elements of factual value, applicability, consistency and neutrality. The interview texts were analyzed and the codes were extracted. Then, the codes were categorized into eight major concepts of presence, instructor as evaluator, instructor as communicator, instructor as experience provider, instructor as motivator, instructor as supervisor, instructor as moderator, and instructor as supporter. Participants in this study emphasized the instructor's key role in forming an appropriate or safe working environment. They revealed that the instructor can play an effective and useful role in clinical learning by providing new information, supporting the students thoroughly, and supervising their performance. In addition to experiencing some levels of dependence, participants accentuated the necessity for establishing a safe environment in order to provide learning opportunities for students. They also confirmed effective role playing by the teacher as an appropriate input for nursing students' needs

Nursing students experiences in reflective thinking: a qualitative study

Reflective thinking has been emphasized as an effective educational strategy by many researchers but there are few qualitative researches regarding the results of its application. This research was conducted to find out the mechanisms by which reflection on practice affects clinical experiences. This qualitative study was performed as grounded theory. The participants were twenty 4[th] year nursing students having 10 weeks experience of reflective thinking program. A guide on reflective thinking was given to students who were asked to write their thoughts about experiences obtained in clinical environment in their personal journals and give them to the researcher on a weekly base. Then, they received an appropriate feedback based on the scales of reflective thinking levels and thinking strategies in nursing. At the end of the mentioned time, students participated in focus group interviews in two groups of ten. Transcripts were analyzed through qualitative method and were coded in three stages during which the data were categorized and named. The names of categories are the themes of this study. Findings demonstrated that the process of reflective thinking influencing clinical experience emerges in 5 domains of caring, thinking, theory and practice integration, self-regulatory mechanisms and motivation. Students' experiences in reflective thinking show that reflective thinking leads to having holistic approach toward patients, affecting thinking, integrating theory and practice, and improving self-regulatory mechanisms and motivation. Motivation variable as a central variable influences 4 other themes and is also affected by them. The element of motivation could be added to this cycle as a central variable. Integrating reflective thinking in nursing programs is recommended

elders experiences of social support in nursing home: a qualitative study

Dramatic increase in the overall number of older adults currently in the population, and further increases expected, heightens the awareness of the need for adequate support for older persons living in the community. The elderly are particularly vulnerable to stress. Transition to the care home and environment of a residential home has been identified in the literature as the most significant relocation affecting older people. Social support plays an important role in managing stress, but, there are a few researches that have investigated the quality and intensity of relationships as a part of social supports for elders, especially those living in nursing homes. Researchers have found that social supports protect elders against the harmful effects of stress and promote emotional and physical wellbeing. Older adults who are connected to active social networks and who receive informal social support have been shown to demonstrate better physical and mental health than those who are less connected and involved with others. For this reason, researchers intend to explore elders' attitude living in nursing home with regard to religious and cultural aspect in Iran. This study aimed understanding elders' perceptions of social support quality during their residency period in nursing home. In this study, the qualitative phenomenological approach was used by several in-depth interviews with elders residents in private and governmental nursing homes were selected by purposive sampling over a 9 months period. Purposive sampling continued until data saturation was occurred where the sample size reached to 10. The data was collected by in-depth interviews. Researchers used field notes for completing data collection process. Colaizzi's method was applied for data analysis. The rigor of present study was based on transferability and credibility. The findings were including: 80 codes, 5 sub-themes and two themes extracted from the data [structural components of experience]. The themes were informal social support in nursing home, and formal social support in this setting. According to older people's attitudes there were three important elements, staff, family and other residents, which have very much important influence in their life providing social support network. In present study, nursing home residents stated various degrees of communication with and sense of support from family, friends and others. All of them stated other people's visits as encouraging and supporting

[ experiences of health care team and elderly in-patients about concept of [elderly patients' education] in a hospital affiliated to Isfahan University of Medical Sciences]

As world population gets older, caring for the elderly becomes one of the most important and challenging duties of health care system. This study was done to describe the educational needs of the elderly hospitalized in acute care settings, based on health care team and patient's actual experiences. Using phenomenological approach, participants were selected from a teaching hospital in Isfahan. A purposive sample of 8 nurses, 4 elderly patients and 2 physicians were interviewed in depth. Colaizzi's analysis method guided the essential activities of the researchers. Following analysis of transcribed interviews, emerging themes were categorized in major concepts and related subconcepts including: interaction with instruments and interventions, hospital self-awareness, mobility and activity, risks management, treatment discipline, accessible care and treatment. The concept of "education" in hospitalized elderly is a vast concept. Provision of adequate and timely information for the hospitalized elderly about expected outcomes and behaviors, physical condition and ways to get help in challenging situations can promote their cooperation in health care procedures. Through educating nurses and medical staff, the goals of "providing comprehensive elderly health care" and "improving nursing care quality" could be achieved

emotional experiences of elderly people regarding the process of residency in nursing homes

There is increasing rate of tendency of leaving elderly people to live in nursing homes in recent years. It is suggested that, the common view of the elderly people towards living in nursing homes is known as "the final sign of failure in the life". It seems that this attitude has a negative influence on adaptation of elders when confronting with a challenge. Therefor, the understanding of the emotional experiences of elderly people to spend their life in nursing homes is important. In this study, the objective was to explore the emotional experiences of elders who living in nursing homes. The research question is "How is structure and meaning of the emotional experiences of elderly people in the Process of Residency in nursing homes?" A qualitative phenomenological approach was used in this study with applied purposive sampling amongst elderly residents in private and public nursing homes in Isfahan. Sampling was continued till data saturation and the resulting sample size consisted 10 participants. The data was collected by in-depth interviews. Field notes was used for completing data collection process and Colaizzi's method was applied for data analysis. The rigor of present study was based on the transferability and credibility. Two themes were extracted from the data [structural components of experience], including: Residents' emotional experiences during nursing home life and Resident's emotional experiences at the entrance in the nursing home. In this study, older people have shown various emotions to relocation and residency in nursing homes. Elders, with different context and different history in their life, had unique experiences. In addition, it is essential to pay attention to social, financial, mental, spiritual and physical needs of elders as components of holistic care. In fact because concerning only physical needs of elderly people can not lead to promote hopeful, meaningful and purposful life for the elderly people

feeling of powerlessness in older people living in nursing homes

All societies in the world are experiencing burgeoning numbers of "elders", defined as persons aged 65 year and older. It is expected that at least 40% of the population over 75 years need extensive health care services in the last years of their lives. Countries with an ageing society have developed long term care policies for older people. In Iran, as the rate of transferring the elderly to the nursing homes is increasing, it would be important to investigate the experience of self-determination, respect and value among elderly people living in these settings. The powerlessness results in loss of hope. In addition, older adults who feel powerless may also lose their independence. In this situation, family members or health professionals take over and make decisions for them. Elders' empowerment can promote their quality of life and well-being. This study aimed at description of the experience of powerlessness in elderly who are living in nursing homes. The research question was "how is the experience of powerlessness in elderly who are living in nursing homes? The qualitative phenomenological approach with purposive sampling was used in this study. Participants in this study were elderly residents of private and governmental nursing homes in Esfahan city. Sampling continued till data saturation occured with 10 participants. The data were collected through in-depth interviews. Researcher used field notes for completing data collection process. Colaizzi's method was applied for data analysis. The rigor criteria of the present study were based on transferability and credibility. Three themes were extracted from the data [structural components of the experience], including: 1] compulsory tolerance, 2] Waiting for exiting permit, and 3] Constrained autonomy. In this study, some participants experienced lack of ability in changing conditions and also compulsory tolerance of the situation, two main findings from which the concept of powerlessness was perceived. Transferring to nursing home is a source of fear and anxiety in the end years of life. For the institutionalized elders, empowerment can come through participating in making decisions regarding patient care and other aspects of life in this setting. In addition, mental, spiritual and physical needs of elders should be met through whole care, because simply focusing on physical needs deprive hopeful, meaningful and purposive life in nursing homes

[Mechanically ventilated patients' experiences]

Endotracheal or tracheotomy tube in mchanical ventilated patients disturb their verbal communication with others. So patients are frustrated of repuesting their needs or problems related to their artificaial breathing. Therefore, an investigation of their own experiences can be applied in providing them with a better care by clinical personnel. This is a qualitative phenomenological survey. The population studied was patients who were mechanically ventilated at least for one time and were more than 12 years old. Data were collected during five months by deep interview and then were analyzed by Collizzi seven-stage method. The findings of research were classified in 139 codes and three categories as: 1] Interapersonal experiences, 2] Extra personal experiences 3] Interpersonal experiences. Mechanically ventilated patients tolerate a lot of stressors of that many are externally sustained. Better care reduces these stressors, and make it easier for the patients to get along with the artificial breathing. Meanwhile, some pleasant experiences were mentioned by patients in this study

Unwanted pregnancy outcomes

Unwanted pregnancy is that in which one of the couples or both did not expect pregnancy. Unwanted pregnancy highly affects couples' health and maternal mortality rate. Nowadays, it is one of the major health problems of under developed countries. Regarding the high ratio of that in Iran, this research has tried to investigate its outcomes so that the strategy makers can precisely look for practical solutions on family planning and decrease those and their outcomes. This is a qualitative study based on grounded theory. The participants included women with unwanted pregnancies, their husbands and health centers personnel. Sample size after data saturation through interviews was revealed to be 18 participants. The data were collected by taped semi-organized verbatim interviews recorded for 45-80 minutes. The interviews were conducted in participants' houses with unwanted pregnancies, health centers and in one of the nursing and midwifery faculties in Iran.Strawbert method was handled to analyze the data. The findings, indulged through qualitative method regarding unwanted pregnancy outcomes were classified as 82 codes and 4 groups containing' economic, physical, emotional, family problems and deprevation of social activity. lack of knowledge, motivation and insuficient understanding of couples regarding counsequences, of unwanted pregnancy caused their ignorance concerning family planning. So, the spouses should equally have family planning counseling to modify their attitude and function toward health systems

Nurse-elderly patients relationship experiences in hospital wards- a qualitative study

There is an increasing aging population in Iran. Most of nurses will be involved in caring for older people in the future. Over the past years, much has been written about the benefit of effective nurse patient relationship. The purpose of this study was to ascertain how nurses and older patient communicate together. Using phenomenological approach, the researcher drew participants from alzahra hospital in Isfahan. A purposive sample of 8 nurses and 4 geriatric patients were interviewed in-depth. Colaizzi, analysis method guided the essential activities of the researchers. The reliability and validity of the present study were grounded on the four items [factual value, applicability, consistency and neutrality] suggested by Guba and Lincoln. Three major themes were identified. These were: 1] task-oriented communication, 2] incomplete communication, 3] appropriate communication. Despite emphases on nurse-elderly patient communication as a basic element of nursing care for older patients, findings show that this condition continues to be poor. We can improve the relationship between nurses and elder patients through communication skills training and also increasing awareness of the nurses about aging phenomena