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

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

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

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

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

[Assessing effectiveness of a cardiac rehabilitation program on outcomes of myocardial infarction]

Cardiovascular diseases are among the major mortality causes world widely. Cardiac rehabilitation reduces cardiovascular mortality and improves cardiovascular and mental status of cardiac patients. The aim of this study was to assess the effectiveness of a cardiac rehabilitation program on myocardial infraction outcome. An experimental study was conducted with a sample of 170 patients [85 patients in each group of experiment and control] with myocardial infraction drawn from Amir Kabir hospital affiliated to Arak University of Medical Sciences. Data was gathered by a questionnaire and an observational check list before and after the intervention for both group. The experiment group participated in two-session cardiac rehabilitation program, once during discharge and one after 2-3 weeks of discharge. Statistical analysis was done by Chi-square test, Fisher's exact test and Ttest. There was a significant relationship between cardiac rehabilitation program and chest pain, dyspnea, fatigue, peripheral edema, palpitation and rehospitalization of patients [P<0.05]. It was demonstrated cardiac rehabilitation program could result less frequent chest pain, dyspnea, fatigue, peripheral edema, palpitation and rehospitalization of the patients as well as quicker normalization of inverted T wave. It calls more attention to cardiac rehabilitation program

[ epidemiology of hospitalized head injury in Arak]

Head injuries are the most sever kind of injuries in accidents. It is an important factor of disability in society. Having information about present situation and its determinant factors is the first step of programming for head injury reduction. This survey aimed to have an epidemiological aspect of head injury in Arak. Relevant informations about severity of the impact, causes, demographic information and treatment results were extracted from medical files between 2005-2006 years. Of total 1105 patients with head injury 25.8% were in their first decade of life and 11.8% were reported as sever head injury. The most common injuries [18.4%] caused by downfall from low height. Men had more head injured 64.7% compared with women. In the period of hospitalization 12.8% of moderate head injuries and 43.1of sever head injury caused to death. It is concluded that applying and administration of the safety rules in the society as a compulsory rules and educating by mass media, are necessary. It should also be taken into account more effective hospital care for sever head injuries to reach better outcomes

[Occupational violence in nursing students in Arak, Iran]

Nursing students are often exposed to verbal abuse and/or physical assaults from patients and patients' families during the course of their training. Although, past studies have explored violence against nurses, a little attention has been paid by researchers to workplace violence against nursing students. The aim of this study is to identify and explore influencing factors on workplace violence in nursing students during their training programs. In this descriptive study, 271 nursing students completed a reliable and valid questionnaire. Participants were working in teaching hospital affiliated to Arak University. In total, 74.9% and 7.38% of the respondents stated that they had been verbally abused and physically assaulted during their training program in the previous 12-months period, respectively. Most of physical attacks were happened by patients whereas most verbal abuses by patients' families. There were no statistically significant differences between sex and different years in violence. Nursing students are often exposed to violence during the course of their training programs. Nursing students require training on how to prevent and respond to workplace violence, and this important topic should be incorporated into the nursing students' curriculum

[Impact of teaching cardiac rehabilitation programs on electrocardiogram changes among patients with myocardial infarction]

Cardiovascular diseases are the most common mortality cause world widely. Cardiac rehabilitation can reduce cardiovascular mortality and improves mental and cardiovascular conditions among cardiac patients. The aim of this study was to assess the impact of teaching cardiac rehabilitation program on electrocardiogram changes among patients with myocardial infarction. A semi-experimental study was conducted with 170 patients with myocardial infarction who were randomly allocated in two groups of intervention and control [85 patients in each group], 2008-2009. Participants were hospitalized in one of the hospitals affiliated to Arak University of Medical Sciences. Sample selection lasted 15 months. A cardiac rehabilitation program in two sessions was presented for experiment group. The first session was held at discharge time and the next 2-3 weeks afterward. Content of cardiac rehabilitation program was included a brief introduction to heart anatomy, exercise, controlling and modifying cardiovascular risk factors such as hypertension, diabetes mellitus, hyperlipidemia, diet, sexual relationships, mental health [e.g. Stress management] and medicine regime. Control group just received the regular care, not the rehabilitation program. A 12-lead electrocardiogram was obtained five times during six months. It was revealed that normalizing of inverted t wave after six month in experiment group was significantly more than control group [P<0.05]. Changes of ST segment and Q wave didn't t show any significant differences between experiment and control groups. The study indicated that teaching cardiac rehabilitation program accelerates normalizing inverted t wave. It clearly demonstrates the valuable outcomes of teaching cardiac rehabilitation program to patients with myocardial infarction

[Frequency of risk factors for atherosclerosis in children with family history of premature myocardial infarction]

Clinical manifestations of coronary artery disease such as myocardial infarction generally have onset from middle age onwards. However, studies indicate that the atherosclerotic process begins to develop during childhood. The purpose of this study was to evaluate the frequency of risk factors for atherosclerosis in children with family history of premature myocardial infarction in Arak city in 2007. This was a cross sectional study in which 209 children and adolescents aged 3-18 years with a family history of early onset myocardial infarction were selected base on convenience sampling. Total cholesterol, low density lipoprotein cholesterol [LDL-C], high density lipoprotein cholesterol [HDL-C], triglycerides, blood pressure, weight and height and fasting blood sugar were investigated. Data were analyzed by SPSS. The prevalence of hypercholesterolemia and hypertriglyceridemia were 28.2% and 20.1% respectively. 19.1% of these individuals had HDL-C values lower than 35mg/dL. 19/1% of them had LDL-C levels higher than 129 mg/dL. 4/31% presented hypertension and 28/71% had excessive weight. There was no relationship between hyperlipidemia and fasting blood sugar. However, there was significant association between hyperlipidemia and level of BMI and blood pressure [P<0.05]. More than a quarter of children had at least one risk factor for atherosclerosis. Obesity was identified to be significantly associated with hyperlipidemia. These results emphasis the importance of evaluating children and adolescents with family history of early onset myocardial infarction for atherosclerotic disease

Comparision between effects of bicarbonate and acetate dialysates on spirometry parameters in patients with chronic renal failure undergoing hemodialysis

Chronic renal failure causes impairment of all body organs including heart and lungs. Main problem in these patients are pulmonary edema due to increased permeability of capillaries, intravascular and interstitial volume overload, hypertension and heart failure. These changes cause altered physiologic and mechanical function of lungs. The objective of this study is evaluating the effect of dialysates and other intervening factors on spirometry parameters. This cross-sectional study was performed on 41 patients with chronic renal failure in September and October 2006 in Labbafi Nejad Hospital, Tehran. Patients were randomly divided to bicarbonate and acetate groups. Prior to and after hemodialysis, patients were meticulously weighed and spirometry parameters [FVC, FEV1, FEV1/FVC%. FEF 25-27] were measured. Biochemical indices were checked. Spirometry parameters were analyzed using t-test, and p-value less than 0.05 was considered statistically significant. We compared 29 patients undergoing dialysis with bicarbonate and 21 patients on dialysis with acetate. Respiratory function improvement in spirometry parameters was only significant in patients undergoing dialysis with bicarbonate dialysate, and when results were compared according to gender, they were statistically significant only in men. This improvement was meaningful in FEF [25-27%], FEV1, FVC. Post dialysis weight loss and serum chemistry had no significant correlation with improvement of spirometry parameters. Dialysis with bicarbonate dialysate causes significant improvement in spirometry parameters and respiratory function in men

effects of sports pathological keys on the macrotraumas injuties of the face and neck among karate athletes in arak

Since participating in sports and exercising has dramatically increased these days, sports injuries have been considered as the major part of the social incidents. Many sports fans of different ages spend their free time exercising karate. Karate has been classified as contact sports in the categories of International Medicine. Based on the studies done, 57% of the damages to the head and face in England and 59% of them in Australia have been reported to be related to Karate. Karate in Iran has been considered as the first cause of damages to the face and jaws among female athletes and as the second cause of such damages among male athletes. Therefore, this study aims at evaluating the rate of injuries caused before and after trainings to provide for recognizing and then modifying the ways of practicing athletic activities. This research is a Semi-experimental study which has been carried out on all the athletes participating in karate matches in Arak. They have been trained in both groups by a face to face method to find out about the causes, related signals and different types of injuries. The data was recorded based on quantity measurements of the number and the type of macrotraumas to the face and head in the selective matches in the team of Arak. The study was carried out one year before and one year after their participation in the annual match. The data was evaluated and analyzed using SPSS software and running a T test. The average age of the athletes injured was 18.08 years, ranging from 16 to 29 years old. There was no significant relation between the age and the injured area. Altogether, there were 71 cases of the head and neck injuries before training and 38 of such cases afterwards. Also, the highest rate of injury prevalence was related to the injury to the soft tissues before and after the training. There was a meaningful difference between the average head injuries and those of the neck. [P< 0.05]. Neck and head injuries have been found to be the most prevalent in Karate in many studies as well as in this study. So, considering the results of this study which show the influence of training stability in decreasing injuries in sports, programming for continuous training and evaluation to raise the knowledge, theory and acquisition of proper sporting behavior among athletes and the trainers can be main steps in preventing sports injuries and the related consequences

effect of some simple exercises and correct daily activity in prevention of backache in pregnancy period

Backache is a common problem in pregnancy period. Scientists believe that some simple exercise can help to prevent the occurrence of backache during their pregnancy period. Thus, this research carried out in order to investigate the effect of some simple exercises and correct daily activity in prevention of backache in pregnancy period. This is a clinical trial study that was carried out on 138 of pregnant women .The first group including 66 women which considered as control group and treatment group including 72 women. The research had four stages: 1] stage of taking history. 2] Arrange a teaching program. 3] stage of performance [In case group samples were done 60 minutes aerobic exercises for 3 days a week for the 30 weeks undersupervision a physiotherapist]. 4] Assessment the results. Data were analyzed by SPSS for statistical analysis. According to the result 18.2% of woman that were under treatment and 36.6% of control group, suffered from backache. Chi-square test showed significant differences between two groups. In addition Odd ratio of treatment population was 2 [CI%95 = 4/04-1/91 and p < 0/05]. The result showed simple exercises during pregnancy period can not eliminate backache, but it can decrease delay backach

[ investigation on quality of emergency care of head injury patients in emergency ward, Vali-e-Asr hospital, Arak 2005]

The third leading cause of mortality in developed countries is trauma which 50% of these is because of head injuries. Since the injury to the brain is not limited to the time of accident and it can be developed or exacerbated some times after the accident, therefore care and treatment of these patients especially during the emergency phase can prevent secondary injuries. So it is important to investigate the quality of these patients' care in emergency phase at hospitals. This is a descriptive study which is done during a 6 months period. It is done using a quality of care checklist which was developed for three groups of patients with mild, moderate and sever head injury .The checklist is developed based an standards of care. The quality of 693 patients' care by health care team [physicians and nurses] was evaluated during the first 24 hours of hospitalization. Four domains of care including general, neurologic, respiratory and homodynamic care were assessed by the checklist. The highest score in each domain was 10. 9 and more was considered excellent care, less than 9 to 7 good, less than 7 to 5 moderate and less than 5 poor. Data was introduced using descriptive statistics. Results showed that the health care team in the domain of general care had 7.39 [good care], in the domain of respiratory care 5.08 [moderate care] and in the domain of hemodynamic care had 7.48[good care], scores. Findings showed that although care of head injury patients was not poor but it was not excellent also, which shows some deficits in the management of these patients. It is necessary to improve the quality of care by educating health care professionals and providing enough equipment for care

investigation on the efficacy of hemodialysis in Vali-e-Asr hospital of Arak city based on urea kinetic model in year 2003

End stage renal disease [ESRD] is a major health problem and each year the number of patients is increasing. If the disease becomes irreversible, patients must always be hemodialyzed. Since mortality rate will increase due to inadequate dialysis, determining the efficacy of hemodialysis and improving its quality is very important. The main goal of this research is investigating the efficiency of hemodialysis. This is a cross-sectional analytical study which was conducted on 103 people who were under dialysis treatment in the Vali-e-Asr hospital of Arak in year 2003. Weight, blood pressure [before and after dialyze], time of dialysis, BUN and Cr before dialysis and 5 minutes after turning of the pump and before the second dialysis were measured. Data was analyzed by T test and Pearson correlation. The mean of KT/V was 0.58 +/- 0.1; normal protein catabolic rate [nPCR], 0.36 +/- 0.11 g/kg per day and time average concentration of urea [TAG], 43.3 +/- 14 mg/d; which had a significant difference with standard measures [p<0.05]. KT/V was 0.49 +/- 0.18 and 0.47 +/- 0.10 for men and women respectively which was significantly different [p<0.03]. There was a positive and linear relationship between education level and TAG, KT/V and number of dialysis per week. Regarding the low efficiency of hemodialysis in 80% of patients and lower levels of hemodialysis efficacy indicators in comparison to standard measures, periodic assessment and also investigating the reasons of low efficacy of hemodialysis is recommended

Renal colic: pathophysiology, diagnosis and management

Renal colic not only leads to significant morbidity, but also imposes a financial burden on society in that it decreases productivity and increases healthcare costs. A review of medical literature regarding reno - urethral colic was performed using MEDLINE and on-line publications, like European Association of Urology [EAU] Guidelines. Clinical presentation of renal colic, mechanisms of urethral peristalsis and pathophysiology of renal colic were studied. An overview of available medical treatments was presented. The classic presentation of acute renal colic is sudden onset of severe pain in flank, primarily caused by acute urethral obstruction. The pain associated with urethral obstruction is caused by a rise in intra luminal pressure which produces an increase in urethral smooth muscle tension. The diagnosis is often made on clinical symptoms. The objectives of therapy at this stage are to eliminate pain, preserve renal function and eliminate the obstruction. Many drugs have been used in the treatment of renal colic, such as NSAIDs, opioid analgesics, and even loco-regional anesthesia and acupuncture. Nonetheless, the safest and most effective treatment has not yet been clearly defined. An accurate understanding of the pathophysiology of reno- urethral colic allows the physician to tailor the best treatment for each patient. Although many drugs have been suggested for treating renal colic, it seems that the first line medications should be NSAIDs, mostly in oral form. Fluid intake is encouraged and chemical analysis of stone should be performed whenever possible

Effect of smoking on prognostic factors of transitional cell carcinoma of the bladder

This study was conducted to evaluate the effects of smoking on the clinical characteristics and growth trend of transitional cell carcinoma [TCC] of the bladder. In a retrospective case-control study from February 2000 to March 2003, patients with TCC of bladder, referred to our clinic, were selected and divided into high-grade and low-grade groups. Groups were matched for other known risk factors and the effect of smoking on size, number, and presenting grade of TCC in each group was evaluated. A total of 185 patients, with a mean age of 65.1 +/- 14.0 year, were included in this study, of whom 36 were females and 149 were males [male to female ratio of 4.1 to 1]. Eighty-three patients were smokers [44.9%] with a mean 20.01 +/- 11.09 packyear [range 0.75 to 60] smoking history. History of smoking was positive in 36.1% of the patients with low-grade tumors; whereas, 90% of the patients with high-grade tumors were smokers [P=0.000, OR=15.9, 95% CI: 6.7-36.9]. There was a statistically significant correlation between the history of smoking and size and number of tumoral lesions [P=0.000, P=0.000, respectively]. Positive history of smoking was also associated with higher grades of tumor in both men and women [OR=12.8 and 8.8, respectively]. This study showed that smoking not only induces bladder cancer, but also, once it develops, it can increase the grade of tumor, resulting in worse prognosis. Thus, smoking cessation might favorably alter the course of bladder cancer

Helicobacter pylori and rosacea

Recent reports have suggested an increased prevalence of Helicobacter pylori infection in patients with rosacea, with some evidence of dermatological improvement in patients treated with antibiotics for this infection. Our study investigates the prevalence of H. pylori infection in rosacea patients in Kerman. Serological examination was done for 29 patients with classical identification of rosacea using the enzyme-linked immunosorbent assay IgG antibody method. Comparison of antibody titres with those of a control group revealed that the prevalence of positive serological tests for H. pylori was significantly higher in the test group. This supports the suggestion of some form of relationship between rosacea and H. pylori infection, though further investigations with larger sample sizes are required for a definite conclusion