Facilitators and barriers to self-management in Iranian men with chronic obstructive pulmonary disease: a qualitative study.

INTRODUCTION: Self-management, as the most common method of chronic obstructive pulmonary disease (COPD) management, is not an isolated behaviour, but a set of physical, social, cultural, psychological and existential factors affecting it. AIM: This study aimed to explore the facilitators and barriers to self-management in men with COPD in the unique social, cultural, political and economic context of Iran. METHODS: This paper reports part of the findings of a qualitative grounded theory study aimed at exploring the process of self-management in Iranian men with COPD, which was conducted in Iran from January 2019 to July 2023. Participants included men with COPD, their family members and pulmonologists. The selection of participants in this research began with the purposeful sampling method. Data was collected using semistructured interviews. Data collection continued until the data saturation was achieved. A total of 15 interviews were conducted with nine patients, three family members of patients and three pulmonologists. The data was analysed using the constant comparative analysis method. RESULTS: The findings of this study showed that knowledge, education, experience, family involvement and financial support are the factors that facilitate self-management. Factors related to deficits include lack of education, lack of treatment support, family cooperation deficit, financial problems, medication obtaining problems and factors related to disease impacts include specific nature of the disease, residual effect, comorbidity and factors related to negative patients characteristics include false beliefs, poor self-efficacy, feeling shame and non-adherence are barriers to self-management in men with COPD. CONCLUSION: Based on results of this study, healthcare providers and health planners can strengthen the factors that facilitate self-management and weaken or remove the barriers to self-management, so that these patients use self-management strategies with maximum capacity to control the disease.

The effect of M technique massage on behavioral state and weight gain in preterm neonates: A randomized controlled trial.

This study aimed to investigate the effect of M technique massage on behavioral state and weight gain in preterm neonates admitted to neonatal intensive care unit (NICU). This was a randomized controlled trial study in which a total of 64 preterm neonates were randomly allocated to intervention and control group. Intervention group received M technique massage and control group received routine care. Neonatal weight and behavioral state were measured for two weeks. After intervention, no statistically significant difference was found between groups in terms of neonatal weight (mean difference: 44.03, 95% CI [-180.66, 268.74]). At baseline, the mean score for behavioral state response was 5.84 ± 2.20 (mean ± SD) in control group and 5.68 ± 2.15 (mean ± SD) in intervention group and the difference was not significant (mean difference: 0.16, 95% CI [-1.21, 1.52]), but 2 weeks later, and also, after intervention, a statistically significant difference was found between groups (mean difference: 2.16, 95% CI [1.19, 3.17]) and (mean difference: 3.03, 95% CI [2.15, 3.91]), respectively, meaning that it was significantly lower in intervention group compared with control group. According to the findings, massage with M technique in premature neonates can have a positive effect on behavioral state, but no effect on their weight gain.

Effect of Self-Management Program on Health Status and Dyspnea in Patients with Chronic Obstructive Pulmonary Disease.

Background: Self-management is becoming increasingly important in patients with chronic obstructive pulmonary disease (COPD) as it is associated with improved clinical outcomes. The aim of this study was to determine the effect of a self-management program on health status and dyspnea severity in patients with COPD. Materials and Methods: This semi-experimental study was done on patients with COPD who were hospitalized at Ayatollah Kashani and Hajar hospitals from July 2017 to November 2019 in Shahrekord, Iran. Sixty patients with COPD were selected and completed three questionnaires, including a demographic questionnaire, COPD Assessment Test (CAT), and Dyspnea Scale (mMRC). The researcher educated the self-management skills to the intervention group, and the control group received routine care only. Three months after the intervention, the questionnaires were completed again by the control and intervention groups. Data were analyzed using descriptive and analytical statistics by SPSS version 24. Results: The results of this study showed that there was no significant difference in health status between the two groups before the intervention (p=0.827). Three months after the intervention, the health status score in the control and intervention groups were 20.93±5.00 and 18.00±5.18, respectively, which this difference was statistically significant (p=0.030). Also, at the beginning of the study, the difference in dyspnea score between the two groups was not statistically significant (p=0.593). However, three months after the intervention, the score of dyspnea in the control and intervention groups was 2.1±0.995 and 1.53±1.074, respectively, which this difference was significant (p= 0.038). Conclusion: This study showed that self-management intervention could improve the health status and reduce the dyspnea of patients with COPD.

The prevalence of anxiety and depression in patients with ostomy: A systematic review and meta-analysis.

AIM: The prevalence of anxiety and depression in patients with ostomy is reported differently. The aim of this systematic review and meta-analysis is to estimate the global prevalence of anxiety and depression in patients with ostomy. METHOD: A systematic search of Embase, Proquest, Scopus, PubMed and Web of Science (ISI) databases was conducted from January 1990 up to 5 May 2021. A total of 3392 records were retrieved and 18 studies were ultimately included. Two reviewers independently assessed full-text of articles according to predefined criteria. A random-effects model was used to estimate the prevalence of anxiety and depression and I2 index was used to assess the heterogeneity of the studies. Subgroup analysis and mea-regression were conducted to explore potential sources of heterogeneity. The review protocol is registered in PROSPERO and is available online. Data analysis was performed using R software version 4.3.1. RESULTS: In this study, the pooled prevalence of anxiety was 47.60% (95% CI, 29.94-65.26) and the pooled prevalence of depression was 38.86% (95% CI, 29.29-48.43). The subgroup analysis showed the prevalence of anxiety and depression in different regions was not significantly different (p = 0.854, p = 0.143 respectively). Nevertheless, the highest and lowest prevalence of anxiety were in Asia and the America 51.79% and 32.69%, respectively and the highest and lowest prevalence depression were in Asia with 49.80% and Europe with 26.77%, respectively. CONCLUSION: The finding of this study showed the global prevalence of anxiety and depression in patients with ostomy is high. Therefore, all health care providers who deal with these patients should use appropriate psychological strategies, techniques and interventions to reduce anxiety and depression in these patients.

Comparison of Face-to-Face Education and Multimedia Software Education on Adjustment of Patients With Intestinal Ostomy: A Randomized Controlled Trial.

PURPOSE: The aim of this study was to compare the effect of face-to-face versus multimedia education on the adjustment of patients to an intestinal ostomy. DESIGN: Randomized clinical trial. SUBJECT AND SETTING: The sample comprised 135 patients with new ostomies randomly assigned to 3 groups (control, face-to-face, and multimedia education). Data were collected from November 2018 to May 2019; the study setting was Rasul-e Akram and Imam Khomeini Hospitals, Tehran, Iran. METHODS: The control group received no additional ostomy education. The face-to-face education group was educated individually in the hospital environment during four 3-hour sessions delivered over 4 consecutive days. The multimedia group viewed a multimedia educational program using a laptop. Data were collected at baseline and 3 months after the intervention. Data collection forms comprised a demographic questionnaire and the Ostomy Adjustment Inventory-23 (OAI-23). RESULTS: Before the intervention, the mean OAI-23 adjustment score did not significantly differ among the 3 groups (P = .752). Three months after the intervention, the mean score of adjustment score in the multimedia software group was significantly higher than those of the face-to-face and control groups (P = .000). In addition, the mean score of adjustment of the face-to-face education group was significantly higher than that of the control group (P = .002). CONCLUSION: Findings indicate that multimedia education was associated with higher levels of adjustment when compared to face-to-face teaching.

Improved COVID-19 ICU admission and mortality outcomes following treatment with statins: a systematic review and meta-analysis.

INTRODUCTION: Approximately 1% of the world population has now been infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19). With cases still rising and vaccines just beginning to rollout, we are still several months away from seeing reductions in daily case numbers, hospitalisations, and mortality. Therefore, there is a still an urgent need to control the disease spread by repurposing existing therapeutics. Owing to antiviral, anti-inflammatory, immunomodulatory, and cardioprotective actions, statin therapy has been considered as a plausible approach to improve COVID-19 outcomes. MATERIAL AND METHODS: We carried out a meta-analysis to investigate the effect of statins on 3 COVID-19 outcomes: intensive care unit (ICU) admission, tracheal intubation, and death. We systematically searched the PubMed, Web of Science, Scopus, and ProQuest databases using keywords related to our aims up to November 2, 2020. All published observational studies and randomised clinical trials on COVID-19 and statins were retrieved. Statistical analysis with random effects modelling was performed using STATA16 software. RESULTS: The final selected studies (n = 24 studies; 32,715 patients) showed significant reductions in ICU admission (OR = 0.78, 95% CI: 0.58-1.06; n = 10; I 2 = 58.5%) and death (OR = 0.70, 95% CI: 0.55-0.88; n = 21; I 2 = 82.5%) outcomes, with no significant effect on tracheal intubation (OR = 0.79; 95% CI: 0.57-1.11; n = 7; I 2= 89.0%). Furthermore, subgroup analysis suggested that death was reduced further by in-hospital application of stains (OR = 0.40, 95% CI: 0.22-0.73, n = 3; I 2 = 82.5%), compared with pre-hospital use (OR = 0.77, 95% CI: 0.60-0.98, n = 18; I 2 = 81.8%). CONCLUSIONS: These findings call attention to the need for systematic clinical studies to assess both pre- and in-hospital use of statins as a potential means of reducing COVID-19 disease severity, particularly in terms of reduction of ICU admission and total mortality reduction.

The Level of Procalcitonin in Severe COVID-19 Patients: A Systematic Review and Meta-Analysis.

There is data from individual clinical trials suggesting that procalcitonin (PCT) may be a prognostic factor in the severity of COVID-19 disease. Therefore, this systematic review and meta-analysis was performed to investigate PCT levels in severe COVID-19 patients. We searched Embase, ProQuest, MEDLINE/PubMed, Scopus, and ISI/Web of Science for studies that reported the level of PCT of patient with severe COVID-19. We included all studies regardless of design that reported the level of PCT in patients with severe COVID-19. We excluded articles not regarding COVID-19 or not reporting PCT level, studies not in severe patients, review articles, editorials or letters, expert opinions, comments, and animal studies. Nine studies were included in the analysis. The odds of having more severe COVID-19 disease was higher in subjects with elevated PCT (≥0.05 ng/mL) compared with those having low procalcitonin (<0.05 ng/mL) [n = 6, OR(95% CI) = 2.91(1.14, 7.42), p = 0.025). After estimating the mean and standard deviation values from the sample size, median, and interquartile range, a pooled effect analysis indicated higher serum PCT concentrations in patients with severe versus less severe disease [n = 6, SMD(95% CI) = 0.64(0.02, 1.26), p = 0.042]. The results of this study showed that PCT is increased in patients with severe COVID-19 infection.

The association between health literacy, social support and self-efficacy in mothers of preterm neonates.

BACKGROUND: Health literacy, social support and self-efficacy are important concepts in mothers of preterm neonates. The purpose of study was to determine the association between health literacy, social support and self-efficacy of mothers of preterm neonates admitted to the neonatal intensive care unit. METHODS: This descriptive correlational study was conducted from November 2017 to January 2019 on 200 mothers of preterm neonates admitted to the neonatal intensive care unit of selected hospitals affiliated with Iran University of Medical Sciences, Tehran, Iran. Data were collected using demographic, maternal health literacy, maternal self-efficacy and multidimensional scale of perceived social support questionnaires. Data were analyzed by descriptive statistics (mean and standard deviation) and inferential tests (Pearson correlation coefficient) using SPSS-PC (v.23) and R software. RESULTS: The data showed 23.5% of mothers had high likelihood of low health literacy, 45.5% had possibility of low health literacy and 31% had adequate with mean score 2.57 ± 1.28. Also, 9.5% of participants had low perceived social support, 62.5% moderate perceived social support and 28% high perceived social support. Maternal self-efficacy score was 52.54 ± 8.06. Pearson's correlation coefficient analyses revealed a statistically significant positive correlation between maternal health literacy and social support (r = 0.304, p < .001). Also maternal health literacy was positively correlated with the self-efficacy (r = 0.292, p < .001) and self-efficacy was positively correlated with social support (r = 0.440, p < .001). CONCLUSION: Health literacy, social support and self-efficacy of mothers of preterm neonates admitted to the neonatal intensive care unit in Iran are related together. Therefore, neonatal care nurses need to note this in care of this clients and adopt strategies to enhance them.