[Pharmaceutical care: a concept analysis using Rodgers' evolutionary method]

The concept of pharmaceutical care has been used and discussed with multiple definitions in the literature related to health care sciences and especially in pharmacology and pharmacotherapy. However, the use of this concept is not common in the nursing literature and it has not currently been used. This study has been done to analysis the concept of pharmaceutical care in order to clarify areas of agreement of this concept in nursing and pharmacology disciplines and identifying its attributes, antecedents and consequences. Rodgers' evolutionary method of concept analysis was used to clarify the meaning of Pharmaceutical care. Data bases of Sciencedirect, Springer and google scholar were searched to retrieve the related literature. The main criteria for entry were, the literature published in English language in the disciplines of nursing and health care sciences. Literature search was limited to 1990-2011 with the keywords of "Pharmaceutical care" and "Pharmaceutical service" in the title of texts. The initial search resulted in 932 texts, 197 of them deemed relevant to our analysis. Then 40 texts [20 percent of those] were selected and reviewed. In this study, the attributes of pharmaceutical care were identified in two categories of specialized skills and communication skills. Specialized skills included five attributes including the identification of drug problems, resolving the drug problems, treatment and palliative care, monitoring short-term results of treatment and reviewing proportionality of prescription for each patient. The communication skills included four attributes of consultation with the patient, emotional commitment to the welfare of patients, collaboration with the health care team and attention to the patient's medical condition. The antecedents included professional and organizational factors, and the consequences were health care, economic, informational and qualitative outcomes. The findings show that in spite of failure to use the concept of pharmaceutical care in nursing literature independently, it is a significant aspect of clinical practice and overall patient care

[Survey of nosocomial infection and accompanied factors in neonatal intensive care unit]

Neonatal Intensive Care Unit [NICU] is considered a major problem regarding nosocomial infection control. Considering the importance of this subject and this point which this study has never performed in this province is necessity of performance of this research. To determine Nosocomial infections and accompanied factors in neonatal intensive care unit [NICU] at 17-Shahrivar hospital of Rasht, 2008-9. This study was a descriptive research and data were collected prospectively through a questionnaire and a checklist. Questionnaire was included demographic characteristic and treatmental factors. Structural and personnal factors were assisted by the checklist. In this study, samples were the same as study population and all neonates who had the characteristics of the research samples were included. Inclusion criterions consist of all of neonates that aged up to 30 days, suffering from prematurity, low weighting, hyaline membrane disease [HMD], respiratory distress syndrome [RDS], congenital anomalies and also neonates who required surgical treatment that manifested clinical infection signs after 48 hours of admission. All neonates that had clinical infection signs on admission time and suffering sepsis, meningities, pneumonia, urinary tract infection and other infections or the ones who were in incubation period were excluded from research. Nosocomial infection was diagnosed by focal point physician based on the National Nosocomial Infection Surveillance system [NNIS]. Data was analysed by using SPSS and by means of frequency distribution tables and graphs. During the study period, 270 neonates were hospitalized, among them 44 cases [16.29%] had nosocomial infection. Most of them [70.5%] were male, weight of them was under 2Kg and age of them was between 1-3days. Also most of them [73%] were preterm and were born by cesarean section method. Assessment of the research based on treatmental factors showed that majority of patients were premature and had respiratory distress. The most common isolated pathogens were entrobacter [57%], klebsiella [9%] and E-coli [2%]. Assessment of Structural factors showed that there are physical space problems in spite of adequate equipments and instruments. Regarding personality situations, it is clear that educational programs have been provided for prevention of infection. It is recommended to pay more attention in personal hygienic, especially hand washing and using stril gloves and sterilization rules regarding in IV cathetering. Also it is advised to control and prevent infections with suitable distribution of staffing, providing standard rules in physical structures and promoting knowledge in physicians and NICU personels

[Comparing dressing with silver sulfadiazine and nitrofurazone on burn wound infection among the patients admitted to the pediatric burn ward in Tabriz, 2005]

Introduction: Burns are among the main public health problems throughout the world especially in the developing countries. In Iran burn injuries causes significant morbidity and mortality, especially among the pediatric population. Infection remains the most common cause of death in the severely burned patients. The proper use of topical antimicrobial agents decreases the occurrence of bacterial resistance and sepsis

Objective: The purpose of this study was to compare two topical antimicrobial agents, Silver Sulfadiazine and Nitrofurazone, with respect to the rate of healing, infection and their treatment

Materials and Methods: This study was a quasi-experimental study that used convenience sampling for 5 months on 60 cases that were admitted in the pediatric burn ward at the burn center of the Sina hospital, Tabriz, East Azarbijan, in 2005. Research population consisted of children who were admitted in this center and from among them; the patients who met the characteristics of research samples were selected after explaining the study to their parents and receiving their permission. They were allocated in random into two groups [control and experimental]. The tools were a questionnaire and a checklist. In this research one group was dressed with Silver Sulfadiazine cream and another group with Nitrofurazone and they were replaced once per day. For burn status assessment, in dressing change time, the wounds were considered regarding to the infection criteria and presence of epithelialization and granulation tissue. Also for each patient, bacterial cultures were taken three times by a swab. Descriptive and analytical statistics were performed using the X[2]-test and T-test by means of SPSS software [version 11.5]

Results: Statistical analysis didn't show any significant difference between the two groups with regard to clinical signs of infection [P= 1.000] and microbiological study [P= 0.739]. Also there wasn't any significant difference between two groups with regard to re- epithelialization time [P= 0.763], hospitalization days [P=0.818] and cost of confinement [P= 0.969]

Conclusion: In this study, our hypothesis based on a difference between two topical antibacterial agents was rejected and it was seen that the efficacy of two drugs [Silver Sulfadiazine 1% cream and Nitrofurazone] were parallel. It indicated that over use of one drug can't be a reason for its efficacy. It seems that more attention should be paid on selecting the drug for burned patient treatment