[Comparison of the effect of breath training and lower extremity aerobic exercise on pulmonary ventilation and maximal oxygen consumption of the patients with chronic obstructive pulmonary disease]

Chronic obstructive pulmonary disease deals with both emphysema and chronic bronchitis and is the fourth leading cause of death in females and fifth in males. These patients often are treated with chemical drugs which are costly and have different side effects. The aim of this study was to compare the effect of two ways of' pulmonary rehabilitation including breath training and lower extremity aerobic exercise on breed expiratory volume in the first second [FEV1] and maximal oxygen consumption [VO2 max] of the patients with chronic obstructive pulmonary disease [COPD]. This study is a randomized experimental controlled clinical trial and included 58 patients. 20 patients in breath training group, 20 in aerobic exercise group and the remaining 18 cases in control group. The study took 8 weeks to be completed and the collected data were analyzed by means of paired t-test, ANOVA, post hoc LSD. In this study post intervention comparison of the mean values of FEV1 and max between the patients in the breath training group and control group showed no significant difference, but a significant difference was noticed between the mean values of FEV1 [p<0.01] and VO2 max [p<0.001] in the lower extremity aerobic exercise group and the control group. The mean values of FEV1 and VO2 max revealed no significant difference before the beginning and after the end of this study. In pulmonary rehabilitation of the patients with COPD, lower extremity aerobic exercise is more effective than breath training in the improvement of FEV1 and VO2 max

[Methods of nursing performance measurement]

Nurses play a critical role in health promotion of their society due to their professional importance. To continue this role, exact methods of nursing performance measurements are necessary. Performance measurement and evaluation is the most difficult stage in control process because it requires collecting data and designing scientific models. Measurement methods presented by researchers consist of patient point managed per nurse[PPMN 1974], therapeutic intervention scoring system with 76 therapeutic procedures [TISS28 1983] and its simplified version with 28 therapeutic procedures [TISS28 1997], time oriented score system [TOSS 1991], measurement of nursing diagnosis for nursing severity index [1992], nine equivalents of nursing man power use score [NEMS 1997], and nursing activity score[NAS 2003]. Prospective payment system that changed performance measurement and evaluation of hospitals' therapeutic personnel was approved in U.S congress in early 1980. In this system, the amount of insurance payment by companies has been identified in advance for each diagnostic related group of patients, based on their diagnosis. On the contrary, nursing services are provided according to human responses not just medical diagnosis. Continuing measurement leads to improved quality care. Measuring quantity of nursing care is much easier than measuring its quality. However, its importance has not been well recognized. It is evident that if authorities do not have enough knowledge about heavy work load of nursing care, they can not apply correct evaluation methods. In Iran, payments for nursing services at home or outpatient clinics have been identified but these services are not recognized in hospitals. Payments for nursing services in hospitalized patients constitute only a little amount of medical expenses under the coverage of insurance companies. Measuring nursing services can be a solution for this problem which will be discussed in this article