comparison of two types of relaxation techniques on postoperative state anxiety in candidates for the mastectomy surgery: a randomized controlled clinical trial

Background: Anxiety among patients after surgery can affect their physiological and psychological well-being. The aim of this study was to investigate and compare the effects of Benson's relaxation and rhythmic breathing techniques on postoperative anxiety in candidates for the mastectomy surgery

Methods: This randomized controlled clinical trial study was conducted with ninety patients in 2013. The patients were hospitalized for the mastectomy surgery in three surgical wards in a teaching hospital, Tehran, Iran. They were randomly assigned into three groups: Benson's relaxation including the cognitive relaxation technique type, rhythmic breathing including the somatic relaxation technique type and control groups. According to the Davidson and Schwartz multi-process theory, the Benson's relaxation and the rhythmic breathing techniques have cognitive and somatic effects, respectively. One day before the surgery, the patients in the intervention groups were trained regarding relaxation and breathing techniques and were asked to perform the techniques under the supervision of the researcher in the night before the surgery. The cognitive somatic anxiety questionnaire was used to measure anxiety before the intervention and half an hour after recovery of consciousness after the surgery. Descriptive and inferential statistics were used for data analysis via the SPSS v.21 software

Results: There were no statistically significant differences between the groups in terms of demographic characteristics. The application of both techniques reduced the level of patients' anxiety after the surgery. The patients in the Benson's relaxation technique group reported only the relief of somatic anxiety. However, the breathing technique patients reported a reduction in both cognitive and somatic anxiety

Conclusion: The Benson's relaxation and rhythmic breathing techniques can reduce postoperative anxiety in patients after the mastectomy surgery

Development and validation of attitude toward gestational surrogacy scale in iranian infertile couples

Background: Surrogacy is one of the most challenging infertility treatments engaging ethical, psychological and social issues. Attitudes survey plays an important role to disclosure variant aspects of surrogacy, to help meeting legislative gaps and ambiguities, and to convert controversial dimensions surrounding surrogacy to a normative concept that eliminates stigma. The aim of this study is to develop a comprehensive scale for gestational surrogacy attitudes

Materials and Methods: Development process of gestational surrogacy attitudes scale [GSAS] performed based on a descriptive cross-sectional study and included a rich data pool gathered from literature reviews, a qualitative pilot study on 15 infertile couples [n=30], use of expert advisory panel [EAP] consisting of 20 members, as well as use of content validity through qualitative and quantitative study by the means of content validity ratio [CVR] and content validity index [CVI]. Also internal consistence using Cron-bach's alpha and test-retest reliability using intracalss correlation coefficient [ICC] were evaluated. Application of GSAS was tested in a cross-sectional study that was conducted on 200 infertile couples [n=400] at Royan Institute, Tehran, Iran, during 2014

Results: Final version of GSAS had 30 items within five subscales including [acceptance of surrogacy], [Surrogacy and public attitudes], [Child born through surrogacy] [Surrogate mother], and "Intentional attitude and surrogacy future attempt". Content validity was represented with values of CVR=0.73 and CVI =0.98. Cronbach's alpha value was 0.91 for the overall scale, while ICC value due to test-retest responses was 0.89

Conclusion: Acceptable level of competency and capability of GSAS is significantly indicated; therefore, it seems to be an appropriate tool for the evaluation of gestational surrogacy attitudes in Iranian infertile couples

Effects of active and passive implementation of ventilator associated pneumonia guideline on nurses' performance in critical care units: a controlled clinical trial

Ventilator associated pneumonia [VAP] is the most common infections in critical care units, which leads to more length of hospital stay, costs, and high mortality. Therefore, prevention is a priority according to clinical guidelines. The aim of this study is determine the effects of passive versus active implementation of VAP guidelines on nurses' performance in critical care units. In this controlled clinical trial, 110 nurses who working in critical care units in selected hospitals affiliated to Tehran University of Medical Sciences were enrolled to study by convenience sampling at three groups, including active intervention group [n = 40], passive intervention [n = 36], and control [n = 34]. First, nurses' performance in prevention of VAP was evaluated by an observational checklist. In passive intervention group, posters containing recommendations of prevention of VAP was installed over the wall for each bed. In active intervention group, in addition to poster installation, there were training sessions with feedback on nurses' performance. In control group without any intervention, just nurses' preventative performance was evaluated before and 1 month later. A month later the nurses' performance were observed. Data were analyzed by descriptive and inferential tests [Fisher's exact test, chi-square, ANOVA, and paired t-test] in SPSS version 16. Results showed that the nurses' mean percentage score in three groups was 46.80 +/- 5.79 and after intervention it changed from 47.76 +/- 4.61 to 63.32 +/- 6.97 [P < 0.001] in active group, from 45.24 +/- 5.72 to 55.03 +/- 10.20 [P < 0.001] in passive group and 47.33 +/- 6.86 to 47.90 +/- 6.06 in control group [P = 0.263]. Nurses' performance in active group improved significantly in comparison to passive group and in passive group, it improved significantly in comparison to control group [P < 0.001]. The results of this study showed that both active and passive methods are effective on nurses' performance in prevention of VAP. Therefore, considering the existing situation in the country and the high workload of nurses, we can offer VAP guideline as a protocol in critical care units

[Nurses performance in prevention of ventilator associated pneumonia]

The ventilator associated pneumonia is a common problem in critical care units. It is associated with increased mortality, cost and length of stay. Nurses have great role in preventing the ventilator associated pneumonia. The aim of this study was to assess nurses' performance in prevention of ventilator associated pneumonia. In this descriptive study, 110 nurses working in selected hospitals affiliated to Tehran University of Medical Sciences were selected using convenience sampling method. A 32-item observational checklist was provided based on the ventilator associated pneumonia prevention guideline. The nurses' performance was observed three times. Data were analyzed using descriptive statistics in the SPSS-16. This study showed that the mean score of the nurses' prevention was 46.8 +/- 5.79. Most of the nurses [66.4%] had poor performance; and 36.6% had relatively good performance. There were no nurses with favorable performance in the prevention of ventilator associated pneumonia. The highest score was in contact precaution [72 +/- 9.67] and the lowest score was in mouth hygiene [18.78 +/- 17.4]. The majority of nurses had poor performance in prevention of ventilator associated pneumonia. More attention should be paid for planning appropriate training programs for nurses and giving adequate facilities to improve health care quality

comparative effects of stretching with aerobic and aerobic exercises on fatigue in multiple sclerosis patients: a randomized controlled clinical trial

The physical activity for people with MS largely affects the amount of fatigue. Increased appropriate physical activity tends to decrease the amount of fatigue. The aim of this study was to compare the effect of aerobic and aerobic with stretching exercises on fatigue in people with MS. The randomized controlled clinical trial was conducted on the members of the MS Society of Tehran, Iran. 120 subjects were admitted between November 2009-April 2011; they were diagnosed with clinically definite multiple sclerosis and Expanded Disability Status Scale scores 1.0 to 5.5 and randomly assigned to two exercise groups and one control group. Outcome assessment was performed at baseline and the end of 3 month period using a checklist containing some demographic, disease variable and fatigue severity scale. The exercises consisted of stretching with aerobic and aerobic exercises. Data were analyzed using SPSS software, version 18.0. Independent t test showed that there are significant differences between the two exercise groups in the pretest [P<0.005]. Analysis of Variance showed that there were significant differences between the exercise groups before and after the intervention [P<0.001]. Stretching with aerobic exercises showed significant improvement in fatigue compared to aerobic exercises alone.

[Impact of pre-hysterectomy counseling on depression among patients reffered toTUMS hospitals]

Hysterectomy is the second most common major surgery among women of reproductive age. Studies have suggested that women do not usually receive adequate information regarding hysterectomy before the surgery. Depression is a common psychiatric condition diagnosed after hysterectomy. The aim of this study was to assess the impact of pre-hysterectomy counseling on depression among women. In this clinical trial, 100 women who had undergone hysterectomy for non-malignant conditionswere selected from two hospitals [women's' hospital and Imam Khomeini hospital] and completed the informed consent forms. Participants were randomly divided into two intervention and control groups. In the intervention group, we implemented the supportive counseling within two sessions. Depression was assessed 1-2 weeks before the surgery and two monthsafter the surgery. Data were gathered using the 30-item SAMA questionnaire [modified BECK questionnaire in Iran] for depression and a demographic questionnaire. The two groups were assessed using the Wilcoxon rank-sum test, Mann Whitney U test and paired-t test. Data were analyzed in the SPSS-14.0. The p-value less than 0.05 was considered significant forall tests. Mann Whitney U test showed no significant difference between the control and intervention groups in the mean score of depression [p<0.001]. In the intervention group, the mean score of depression was 44.46 +/- 6.7 at baseline and 20.86 +/- 5.9 after the intervention. Pre-hysterectomy counseling should be provided for women in order to reduce negative psychological consequences

[ comparison between the effect of stretching with aerobic and aerobic exercises on fatigue level in multiple sclerosis patients]

Fatigue is among the most common symptoms of multiple sclerosis. Hence, exercise is recommended to multiple sclerosis patients. This research has been conducted to compare of stretching with aerobic and aerobics exercises on fatigue levels in patients. In this experimental study designed as a clinical trial, 80 eligible patients with multiple sclerosis referred to MS society in Tehran were selected according to inclusion criteria and then were randomly divided into two groups [stretching with aerobic and aerobics]. The data gathering tool was a questionnaire consisted of two parts. The first part contained demographic characteristics, and the second part included fatigue severity scales [FSS]. Exercises were done for 18 sessions and the exercise execution and period were assessed using a checklist. Data were analyzed using chi-square, paired and independent t-tests, and analysis of covariance. There were significant difference between the two groups in pretest fatigue level [p<0.005]. Analysis of covariance showed that the mean of posttest fatigue level was significantly different between stretching with aerobic and aerobics groups and before-intervention fatigue severity was moderated [p=0.001]. According to the findings of this research, both aerobic and stretching exercises are effective in reduction of fatigue in the multiple sclerosis patients. However, stretching with aerobic exercise is more effective in the decrease of fatigue

[Effect of application of critical-care pain observation tool in patients with decreased level of consciousness on performance of nurses in documentation and reassessment of pain]

The presence of pain is a common phenomenon among patients in critical care units. Critically ill patients are often unable to communicate because of illness or sedation; so, recognition and assessment of their pain is difficult. In these patients, observational behavioral indices can be used to evaluate pain. The aim of this study was to investigate the effect of application of critical-care pain observation tool in patients with decreased level of consciousness on performance of nurses in documentation and reassessment of pain after palliative intervention. In this before and after quasi-experimental study, 106 nurses working in general intensive care units in selected hospitals affiliated to Tehran University of Medical Sciences were selected. First, we examined the nurses' performance three times in relation to documentation and reassessment of pain after palliative intervention, position change and suction procedure in patients with decreased level of consciousness using a researcher-made check list. Then, we taught nurses individually, how to use this tool to investigate the pain of patient in a session lasting an hour. A week after the training, the researcher reevaluated performance of trained nurses in relation to documentation and reassessment of pain after palliative intervention in patients with decreased level of consciousness. Finally, those data collected before and after the training of the CPOT to nurses were compared using the Wilcoxon test. Findings showed that the CPOT could not lead to improved nurses' function in relation to documentation of pain in the patients records [P=0.209] and recording palliative measures related to pain [P=0.117]. However, there were significant statistical differences between nurses' function in relation to reassessment of pain after palliative intervention, before and after the training and application of the CPOT. Comparing the mean function scores before and after the intervention, demonstrated that the performance of nurses in this area has been improved after the intervention. The critical-care pain observation tool can increase nurses' sensitivity to pain in patients with decreased level of consciousness. It forces the nurses to reassess the pain after palliative intervention. This tool does not motivate in nurses to document pain palliative process. So it is recommended that future studies investigate the impact of this tool on other aspects of pain management, such as diagnosis of pain and using of drugs and non-drug measures

Relationship between nurses' knowledge about pain and satisfaction of pain relieving procedures among postoperative CABG patients

The aim of this study was to investigate the relationship between nurses' knowledge about pain and satisfaction from pain relieving procedures among postoperative CABG patients in selected Tehran medical university hospitals. In this cross-sectional study, 100 nurses were recruited from the ICU Open heart. Also, 200 patients were selected from whom underwent CABG in 24 hours after surgery and were extubated using a simple random sampling method. Data were gathered using two questionnaires including 17 question about demographic characteristics of patients and their satisfaction, and 36 questions about demographic characteristics and nurses' knowledge about pain and pain control after the CABG. Data were analyzed using descriptive and inferential methods using SPSS-11.5. There was not significant relationship between the nurses' pain knowledge and the patients' satisfaction. However, there were a -significant relationship between the knowledge of the nurses about pain control after the CABG and the patients satisfactions [F=0.209, P-0.037]. According to the findings of the study, there were some significant relationships between the nurses demographic and pain knowledge with the pain control after the CABG. There was also significant relationship between patients' satisfaction and some of them demographic characteristics

[Hypertension and lifestyle in 24-65 year old people in Qazvin Kosar region in 2007]

Lifestyle affects human health and thus, many health problems are related to people's lifestyles. It is also considered as a modifiable factor in Hypertension. The aim of this study was to determine risk factors of hypertension which are related to lifestyle, in 24-64 year old people in Kosar region of Qazvin city. This was a case - control study, consisting of 450 people who were selected through systematic sampling. The data collection instruments were lifestyle questionnaire and data registration paper that their validity and reliability were determined by content validity and test-retest, respectively. People with blood pressure > 140/90 mmHg were regarded as cases while the rest were regarded as controls. Data were analyzed by SPSS version 11.5 using descriptive and analytical statistics. The cases and controls had statistically significant difference in term of physical activity [p<0.01], smoking [p<0.001] and BMI [p<0.001]. Results showed that physical activity, smoking and obesity affect the incidence of hypertension in this region. These results necessitate interventions to change lifestyle of inhabitants of this region