effect of combined decongestive therapy and pneumatic compression pump on lymphedema indicators in patients with breast cancer related lymphedema

Lymphedema treatment is difficult and there is no consensus on the best treatment. This study evaluated the effect of combined decongestive therapy [CDT] and pneumatic compression pump on lymphedema indicators in patients with breast cancer related lymphedema [BCRL]. Twenty one women with BCRL were enrolled. The volume difference of upper limbs, the circumference at 9 areas and shoulder joint range of motion were measured in all patients. CDT was done by an educated nurse in two phases. In first phase, CDT was accompanied by use of a compression pump for 4 weeks, 3 days per week. In second phase, CDT was performed daily without compression pump for 4 weeks by patients at home. At the end of each phase, the same primary measurements were done for patients. The mean volume difference of the upper limbs and mean difference in circumference in all areas at different phases decreased significantly. Mean flexion, extension, abduction and external rotation [in degrees] at different phases increased significantly. CDT significantly reduced mean volume and mean circumference of the affected limb, and significantly increased shoulder joint range of motion. The findings support the optimal effects of CDT in the treatment of secondary lymphedema of upper extremity

[Decrease in motivation of nursing students: a qualitative study]

Introduction: Motivation has been known as a most important factor in directing people for doing activities. Lack or low of motivation affect all domains of human functions and caused negative effects. The aim of this study was identifying perception of nursing students from decrease in theirs motivation to nursing

Methods: This study done with qualitative approach and using thematic analysis method. Twelve nursing students from the Fasa University of Medical Sciences were selected through purposive sampling and interviewed in three focus group interview. After data collection, all interviews were transcribed and reviewed and themes extracted. Then a list of themes prepared and similarity in meaning and concept were reviewed and based on centralization arranged in a sub-category. Then with reviewing again relevant sub-categories arranged in a category

Results: Using analysis of transcribes a significant number of preliminary themes and 6 main themes that each having few other sub-themes were extracted. The main themes included Socio-cultural, educational, managerial, research, communicational and contextual

Conclusion: The results of this study revealed that communication problems with students are the most important factor in lack or low motivation toward nursing. It is recommended that nursing instructors and managers considered above items for promoting motivation of students toward nursing

[Nursing students' perspective toward clinical learning environment]

The prosperity of nursing educational programs depends on the efficiency and sufficiency of clinical experiences. One of the most important factors recognized in this field is learning environment. In this study, different aspects of clinical environment have been evaluated from students' viewpoints. All interns attaining clinical experiences in the wards of pediatrics, neurosurgical ICU, recovery, surgical ICU, surgical emergencies, men medical emergencies, and obstetrics and gynecology took part in this descriptive cross-sectional study. Data gathering tool was a 50 item questionnaire developed through combining two questionnaires of clinical learning environment scale and clinical learning environment and supervision. Students assessed their clinical environment by completing this questionnaire during the second semester of 2006-2007 academic year. Data was analyzed by SPSS software using ANOVA and Post-hoc tests in order to compare the means of the ranks. The mean of given ranks to the learning environment of different wards varied from 1.4 to 4.1 out of five. Four wards of surgical emergencies, male medical emergencies, pediatrics and recovery received a score of 3 or less while, other 3 wards had a score between 3 and 4. The evaluated wards were different in 6 of the variables including management pattern of ward administrator, learning in the ward, the commitment of nursing supervisor, the manner of communication with patient, the relationship between personnel and students, and students' satisfaction. But, no significant difference was observed in nursing students' perception of the ward's atmosphere, the status of nursing care, and interpersonal and supervision relationships in different wards. From the students' viewpoints, learning environment and its related variables vary in different wards. More attention has to be paid to the quality improvement of different wards

effect of educational intervention on the knowledge and participation of administrative health personnel in colorectal cancer screening program at Shiraz university of medical sciences Shiraz 2003

Health care providers play an important role in planning and implementing policies to improve health behavior in the general population and increase participation in screening programs for early detection of cancer. This study was conducted to examine the effect of education on knowledge and the rate of participation of official administrative personnel with average risk for colorectal cancer, [age> 40 years], in colorectal cancer screening program at Shiraz University of Medical Sciences. In the first stage of the research, 156 subjects were selected based on predefined criteria using a questionnaire. They were then randomly divided in two groups, experimental and control groups with 78 subjects in each group. Demographic data, level of knowledge, willingness and perceived barriers to participate in screening programs were examined via two separate questionnaires. They were also asked to give stool samples to test for occult blood. In the second stage of the research, the intervention program, [based on health belief model] was conducted for the experimental group. An educational booklet and necessary information regarding colorectal cancer and screening programs were provided to them in two to three sessions. All subjects were asked to submit the stool samples to the laboratory for occult blood test; if a subject did not comply, a reminder was sent to him/her. In the third stage, knowkdge, [post-test] and the rate of subjects' participation in the screening program was analyzed. The results of the study revealed that most people are not interested in colorectal tests. Reasons given for disinclination for occult blood test and colonoscopy were lack of time and feeling healthy, respectively. Knowledge in both experimental and control groups regarding colorectal cancer was improved, this improvement was significantly higher in the experimental group, [p<0.001]. Furthermore, participation of the experimental group in the screening program was significantly higher than that of the control group [p<0.001]. Educating the subjects regarding colorectal cancer and sending reminders regarding stool tests may result in an increase in the knowledge and participation of subjects in screening programs for colorectal cancer

Comparing the effect of teaching breast self-examination by peers and health care personnel on students knowledge and attitude

Training breast self-examination by peers provides an appropriate situation in order to form proper health behaviors during the adolescence age. The aim of this study was to compare the effect of training breast self-examination by peers and health care personnel on students' knowledge and attitude. In this quasi-experimental study, 112 students from two schools of dentistry and management of Shiraz University of Medical Sciences were selected randomly and were allocated in two groups. They were taken a pre-test and two post-tests. Data gathering tool was an assessment test evaluating their knowledge about breast cancer and self-examination and their attitude toward breast self-examination. Four or five students from each class were selected and trained as peer instructors. Students of the first group were trained by peers and the students in the second group were instructed by health care personnel separately using booklet. At the end of educational sessions, the first post-test, and after 6 weeks, the second post-test were taken. Statistical analysis was performed using paired t-test and independent t-test, repeated measure ANOVA, and factor analysis test. There was a significant difference between knowledge and attitude scores of the two groups immediately after education, so that, the mean score of knowledge in the group trained by peers was higher than the one educated by health care personnel. But, no significant difference was observed between the attitude scores of the two groups, 6 weeks after education. Comparing the knowledge and attitude scores, before, immediately after and 6 weeks after education showed a significant difference in each group. The efficacy of training breast self-examination by peers is higher than by health care personnel. It is recommended to employ this educational method more, especially in training self-examination

[Assessing Stages of dietary change and nutrition attitudes in nursing and midwifery students in fatemeh faculty of nursing and midwifery in 2006, Shiraz]

Nutrition plays an important role in maintaining health and preventing diseases. Students' attitude toward foods can also have an important role in their nutritional behaviors. The study aimed at exploring the stages of dietary change with regard to socio-demographic variables [age, sex, marital status, year/field of education and BMI] and the nutrition attitudes of nursing and midwifery students of Fatemeh faculty of nursing and midwifery in Shiraz. This descriptive study was conducted on 300 freshmen to senior students of nursing and midwifery who were studying varyingly in first year of education to four. Trained interviewers interviewed the subjects based on the transtheoretical Prochaska model, by which the subjects are classified in six stages of changes in nutritional behaviors. Nutrition attitudes were assessed by three questions. All statistics were computed by the SPSS software data. It was found that 29.3% of the students were in the precontemplation stage and 50.3% of the students are in the dynamic stage [including contemplation, decision and action]. 11 and 9/3 percent of students were in the maintenance and relapse stages, respectively. Most of the students with average age of 21.5 were in the dynamic stage. Most men [48.8%] were in the precontemplation stage, and most women [53.6%] were in the dynamic stage. Most single and married subjects were in the dynamic stage [48.8%, 58.1% respectively]. Most freshmen to senior students [47.8%, 55.9%, 49.4%, 47.8% respectively] were in dynamic stage. Most of the subjects in the underweight, normal weight and overweight categories were in dynamic stage [53.9%, 49.6%, and 51.8% respectively]. Regarding eating attitude, the results demonstrated that most of the nursing [51%] and midwifery students [59%] feel a need to change their diet. Moreover, they think about the dietary aspects of their food [78.4%, 82% respectively]. In addition, they expressed their agreement to the item of seeking information regarding healthy diet [83.3%, 85.9% respectively]. The status of nursing and midwifery students considering stages of dietary change and their nutrition attitudes were positively appropriate. To consider nutrition principles for teaching to students, who are educating to manage patients' issues regarding their nutrition, seems to be an important factor in achieving such results. The study recommends duplicating the study on other nursing and midwifery students as well as in other university programmes

[Senior medical students' self evaluation of their capability in general competencies in Shiraz University of Medical Sciences]

Evaluating graduates' proficiencies can provide a helpful reflection of medical education performance and lead to its improvement. The aim of this study was to assess general competencies of final year medical students from their own viewpoints. In this descriptive-evaluative study, 71 graduating students of Shiraz University of Medical Sciences evaluated themselves based on a 101 item evaluation form with Likert scale, in 17 general medical competencies. Calculating the mean scores given to the items related to each competency, their score in each competency was determined. Medical graduates of this university had the mean scores of more than 3.5 for each competency. The highest scores belonged to the competencies including case presentation [4.94 +/- 0.75], basic procedures [4.83 +/- 0.47], tests interpretation [4.69 +/- 0.53], and diagnostic decision-making [4.69 +/- 0.66]. The lowest scores belonged to geriatrics [3.56 +/- 0.75], nutrition [3.56 +/- 0.84], practice management [3.73 +/- 0.80], and advanced procedures [4.02 +/- 0.75], respectively. The medical education program in Shiraz University of Medical Sciences is more patient-centered rather than community oriented. Therefore, improving the competencies needed by the society such as geriatrics, nutrition, practice management, and advanced procedures requires more attention in the educational programs as well as continuing medical education. Improving these competencies can result in a better care delivery by general practitioners in the community

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

[Reliability and validity of OSCE in evaluating clinical skills of nursing students]

Objective structured clinical examination [OSCE] is one of the preferable means of evaluating cognitive, emotional and psychomotor aspects of nursing students. The present study was designed to determine the reliability and validity of OSCE in evaluating clinical skills of nursing students. For this descriptive study, 10 different skills of nursing students were selected. Then, 37 students performed these skills at 10 different OSCE stations, during which two experienced inspectors evaluated their performance. Finally, the correlation between OSCE scores and the mean theoretical and clinical performance scores of students was calculated. Meanwhile, the correlation between the total OSCE scores with OSCE score of each station was determined. Inspectors' reliability [correlation between scores reported by inspectors at each station] was also calculated. The correlation coefficient of OSCE scores and mean theoretical and clinical performance scores were 0.38 [p=0.031] and 0.52 [p=0.005], respectively. Correlation coefficient of inspectors' reliability was in a range of 0.38-0.95. OSCE is strongly suggested as a reliable and valid means of evaluating nursing students' clinical skills

[ effect of cool dialysate on intradiaytic hypotension among end stage renal disease patients]

Hypotension is the most frequent adverse event during hemodialysis. Cool dialysate is a simple and cost effective measure in treating intradialytic hypotension by stabilization of core body temperature. This study was designed to find out the effects of cool dialysate on the frequency of intradialytic hypotension, presenting symptoms and intervention measures used for patients undergoing hemodialysis In this randomized cross-over clinical trial, patients with intradialytic hypotension were detected based on the pre-defined inclusion criteria. Then, they were randomly assigned to treatment [cool dialysate] and control [conventional dialysis] groups. After 1 month, they crossed over as control and treatment groups. Data analysis [paired t-test] revealed that cool dialysate was associated with decrease in frequency of hypotension and number of interventions while improving symptoms and an increment in systolic and diastolic blood pressure. Cool dialysate is an effective tool in maintaining intradilaytic hemodynamic stability, alleviating symptoms of hypotension and the interventions applied for intradialysate hypotension. Therefore, cool dialysate is recommended in hemodialysis patient

[Comparison of post extubation complications in 3 different states of filling endotracheal tube cuff with lidocaine 4% in elective surgery patients]

Endotracheal intubation during general anesthesia is necessary to control the ventilation of patients during surgery. Nevertheless, the endotracheal tube as an external object can stimulate the patient's airway during the emergence from general anesthesia and create different reactions and complications. To prevent these reactions, a wide variety of interventions have been examined. In this study, post-extubation endotracheal tube complications are investigated in 3 different states of lidocaine 4% for filling endotracheal tube cuffs. In this quasi-experimental clinical trial study executed in one of Shiraz hospitals during 2005-2006, 200 candidates of elective surgery being in class1 and 2 ASA were randomly divided into 4 groups [N=50]. The endotracheal tube cuffs of each group members were filled with [5-10mI] distilled water, lidocaine 4%, alkalized lidocaine 4% and warmed alkalized lidocaine 4%, respectively. The patients were observed for complications such as cough [for 6 hrs], sore throat, hoarseness [for 24 hrs] and laryngospasm [immediately] after extubation. The data were analyzed by chi square and logistic regression using SPSS. The findings revealed that the frequency of cough, sore throat and hoarseness was more in the control [distilled water] group as compared to the 2 groups of the study [alkalized lidocaine 4% and warmed alkalized lidocaine 4%]. Distilled water and lidocaine 4% groups differed significantly in only the frequency of sore throat. The odds ratio of cough, sore throat and hoarseness was just significant for the distilled water group in comparison to warmed alkalized lidocaine 4%. Furthermore the odds ratio of the above-mentioned complications was significant for the distilled water and lidocaine 4% groups in comparison to the warmed alkalized lidocaine 4% group. Among all the considered variables, the duration of tube existence in trachea was significantly effective in the frequency of complications. Filling endotracheal tube cuffs with alkalized lidocaine 4% and warmed alkalized lidocaine 4% decreases the frequency of the post-extubation complications [cough, sore throat and hoarseness]. The odds ratio for the observed complications is less in the warmed alkalized lidocaine 4% group as compared to other groups