فهرست مطالب

Iranian Red Crescent Medical Journal
Volume:17 Issue: 9, Sep 2015

  • تاریخ انتشار: 1394/06/14
  • تعداد عناوین: 16
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  • Alireza Mohebbipour, Homayoun Sadeghi-Bazargani *, Mona Mansouri Page 1
    Background
    Regardless of the overall association between diet and acne which cannot be easily ignored, there might be an association between specific nutrients and acne development or improvement..
    Objectives
    The aim of this study was to assess the effect of dietary intake of sunflower seeds on acne severity and the pattern of acne lesions..Patients and
    Methods
    In a randomized controlled trial, 50 patients aged 15 - 30 years old with acne vulgaris were enrolled through consecutive convenient sampling, in a dermatology clinic in Ardabil, Iran. They were randomly allocated into two trial arms. Those in the control group were asked to stop eating sunflower seeds if they did before. In the intervention group, they consumed 25 g sunflower-containing food daily for seven days. The primary outcome of interest was 10% increase/decrease in the baseline acne severity index (ASI), sustained to the end of the follow-up period on day 14..
    Results
    The mean ASI did not change significantly through the study period in the control group, but it increased in the sunflower group from 62 at the baseline to 86.8 after two weeks (P < 0.001). The ASI mean change was 24.8 in the sunflower group compared to 4.9 in the control group (P < 0.001). The global acne grading score (GAGS) did not significantly change in any of the groups and the difference in the change of GAGS was not significant between the groups (2.4 in the sunflower group versus 1.6 in the control group). Twenty two subjects (88%) in the sunflower group versus 9 (36%) in the control group had at least 10% increment in ASI throughout the follow-up period (P < 0.001). The relative risk of developing the primary outcome in taking the sunflower seed intervention was 2.4 (95% CI: 1.4 - 4.2). The observed risk difference was 0.52 (95% CI: 0.29 - 0.75)..
    Conclusions
    Sunflower seed intake appears to aggravate acne vulgaris; however, further evidence is needed to ban sunflower seed intake in patients with acne. Considering the observed potential negative effect in this trial, future randomized clinical trials may base their design on randomly assigning the exposed patients to give up use of sunflower seed intake..
    Keywords: Acne Vulgaris, Diet, Sunflower, Dietary Fats, Feeding Pattern
  • Onder Ayyildiz *, Simel Ayyildiz, Ali Hakan Durukan, Gungor Sobaci Page 2
    Introduction
    Progressive hemifacial atrophy, known as Parry-Romberg syndrome (PRS), was first described by Parry in 1825. There is a progressive atrophy of facial tissues including skin, bones and muscles. Ophthalmic disorders are common and include keratitis, uveitis, cataract, ipsilateral enophthalmos, optic neuritis, retinal vasculitis and scleral melting..
    Case Presentation
    We describe a patient with progressive hemifacial atrophy at right facial side who developed granulomatous uveitis and periferic retinal vasculitis in his left eye. We started topical and systemic steroid therapy. Uveitic reaction had regressed almost entirely after a 3-month steroid treatment..
    Conclusions
    The individuals should have multidisciplinary approach for the variety of disorders to maintain the appropriate treatment for a better appearance of the patients..
    Keywords: Progressive Hemifacial Atrophy, Parry Romberg Syndrome, Uveitis
  • Alireza Mehrazmay, Alireza Karambakhsh, Mahmood Salesi, Mostafa Heydari, Khodabakhsh Ahmadi * Page 3
    Background
    Military service is a stressful task that influences the life style of army personnel. Several factors can make soldiers less capable of coping with stressful events; so they may try to start drug abuse or increase in the amount or diversity of substance abuse. Understanding factors responsible for this misbehavior among soldiers is crucial for their commanders to modify these factors..
    Objectives
    This study aimed to determine the predictors of change in substance abuse status in soldiers..Patients and
    Methods
    This cross-sectional research was conducted to evaluate the substance abuse status among Iranian soldiers in 2010. The target population was the soldiers who had spent at least 3 months of their military service. Cluster sampling was done from army service garrisons in 12 provinces in Iran. A total of 3960 soldiers were selected with different levels of education and age. Data gathering was done with demographic questionnaires, Texas Christian university (TCU) drug screen II and ASI questionnaire (fifth edition). Four types of dependent variables were defined: “improvement”, “without change”, “deterioration”, and “severe deterioration”. Backward ordinal regression analysis was done and P values, OR, and SE were calculated by SPSS19 software..
    Results
    Totally, 6.7% of soldiers improved, 82% remained without change, 6.1% deteriorated, and 5.2% severely deteriorated with regard to their substance abuse. Modifiable predictors were distance from home lower than 200 km (OR =1.54), bad relationship with commanders (OR = 1.88), service place dissatisfaction (OR = 1.39), and always feeling lonely (OR = 1.83). Non-modifiable factors were alcohol use within family and friends (P = 0.000); psychiatric drug use history (OR = 1.72); suicidal attempt history (OR = 1.31); divorce, separation, and extramarital contact (P = 0.001); unemployment (P = 0.019); leisure time dissatisfaction (P = 0.004); living alone (OR = 2.43); and substance abuse onset before age 15 (OR = 1.71)..
    Conclusions
    Considering non-modifiable risk factors, leaders and commanders may recognize more vulnerable soldiers and try to resolve modifiable factors and decrease the risk of getting worse (with respect to substance abuse) about 7.3 times..
    Keywords: Military Personnel, Substance, Related Disorders, Risk Factors
  • Sima Mansoori Derakhshan, Fatemeh Zeinali Sehrig, Nasrin Sohrabi, Siamak Shiva, Behzad Baradaran, Mahmoud Shekari Khaniani * Page 4
    Background
    Type 1 diabetes mellitus (T1D) is an autoimmune disease. Several associations between human leukocyte antigen (HLA) complex and T1D were found in various populations. Associations with various HLA types depend on the investigated populations. However, such associations have not yet been investigated in the East Azerbaijan state of Iran with Turkish ethnicity..
    Objectives
    The aims of the current study was to describe T1D genetic susceptibility conferred by HLA class II alleles (DRB1*0301, DQA1*0501 and DQB1*0201) and to determine haplotype frequencies among T1D patients..Patients and
    Methods
    This study was a case-control study. The number of samples was determined using the Cochran formula. Eighty unrelated T1D patients, including 42 (52.5%) females and 38 (47.5%) males, were randomly recruited from the East Azerbaijan state of Iran. Typing of HLA was performed by polymerase chain reaction-sequence-specific priming (PCR-SSP) on DNA extracted from peripheral blood mononuclear cells of 80 unrelated patients and 80 unrelated healthy control donors, who were selected randomly. For haplotype analysis, the logistic regression model was performed that allows joint estimation of Single-nucleotide polymorphisms (SNPs) via haplotypes..
    Results
    The frequency of drb1*0301 (82.5% vs. 11.3%), dqa1*0501 (82.5% vs. 36.3%) and dqb1*0201 (81.3% vs. 35%) were significantly higher among patients compared with that of healthy subjects..
    Conclusions
    Our investigation demonstrated that there is a highly significant association between the studied alleles and T1D. It can be construed that haplotype HLA-DR3-DQ2 has a very modest effect with respect to the risk of T1D..
    Keywords: Haplotype, Genotype, HLA, DRB1, HLA, DQB1
  • Ali Navidian, Hossein Ebrahimi, Roghaieh Keykha * Page 5
    Background
    Patient satisfaction is the most important criterion in evaluating the quality of care. Besides, its assessment in patients with severe mental disorder treated by electroconvulsive therapy (ECT) is highly appropriate. The ECT is accompanied by lower satisfaction and may exacerbate the patients’ condition..
    Objectives
    The current study aimed to determine the effect of supportive nursing care on the satisfaction of patients receiving ECT..Patients and
    Methods
    This randomized controlled trial was conducted in the education center of Baharan psychiatric hospital, Zahedan, Iran. Seventy hospitalized patients receiving ECT were randomly divided into two groups of control (n = 35) and intervention (n = 35).The socio-personal and Webster Satisfaction Questionnaire were used as data collection tools. The intervention group received supportive nursing care by nurses trained in informational, emotional, and physical aspects. The control group received only regular nursing care. The levels of satisfaction were measured and compared between groups, before and after the intervention. Data were analyzed using the SPSS software, and Chi-square, independent and paired t tests, as well as covariance analysis were performed..
    Results
    The results showed similarities in socio-personal characteristics of both groups. However, there was a significant difference (P < 0.001) between the means of satisfaction in the groups, predominantly for the intervention group. In other words, a significant difference (P < 0.001) was observed between the means of satisfaction of the intervention (54.71 ± 5.27) and control (36.28 ± 7.00) groups after intervention by controlling the effect of socio-personal variables..
    Conclusions
    Results of the current study confirmed the effect of supportive nursing care on increasing the level of satisfaction in ECT receiving patients, recommending the use of this therapeutic method..
    Keywords: Nursing Care, Patient Satisfaction, Electroconvulsive Therapy, Support
  • Songul Aktas *, Kiymet Yesilcicek Calik Page 6
    Background
    Women are seriously subjected to psychiatric diseases during pregnancy and depression is the most prevailing one among these diseases. There is a relation between the social support and depression in pregnancy whose predisposing factors are genetic, psychological, biological, environmental, and hormonal..
    Objectives
    This study aimed to determine the frequency of depression symptoms, and its risk factors. Also it studied the correlation between social support and pregnancy depression..Patients and
    Methods
    This research is a descriptive cross-sectional study. It was conducted on 266 pregnant women selected by simple random method from all pregnant women admitted at the Maternity Hospital of Trabzon, Turkey from May 21 to June 13, 2008. The data were collected with a questionnaire form, the Beck depression inventory (BDI), and the multidimensional scale of perceived social support (MSPSS)..
    Results
    The mean BDI score of the pregnant women was 11.12 ± 6.65. According to the BDI, 46.2% of the pregnant women had no depression symptoms, 34.59% of them had mild, 13.91% had moderate, and 4.89% had severe level of depression symptoms. It was found that such factors as the educational level of the pregnant women and their husbands, having an undesired pregnancy, suffering from a chronic disease before pregnancy, presence of pregnancy-related problems, having a child with disability or having relatives whose children had disability, and smoking during pregnancy were the risk factors affecting the severity of the depression symptoms and these results were statistically significant (P < 0.05). On the other hand, the mean MSPSS score was 67.89 ± 14.26 and it was found that the pregnant women got the highest social support from their husbands. It was found that there was a significant correlation between BDI and MSPSS total score and its subscale scores (P < 0.05)..
    Conclusions
    According to this study, one-fifth of pregnant women were found to experience depressive symptoms, which require treatment during pregnancy, and the factors such as having no support from relatives was found to be associated with the severity of depressive symptoms during pregnancy..
    Keywords: Pregnancy, Depression, Risk Factors, Social Support, Turkey
  • Freidoun Sabzi, Babak Eizadi, Nasrin Javid, Reza Faraji * Page 7
    Introduction
    Congenital thymic cyst (CTC) is a rare mediastinal mass and the retrocaval position of this cyst has not been reported in the medical literature so far..
    Case Presentation
    The present study reports on a 66-year-old female with coronary artery disease (CAD) who was scheduled for coronary artery bypass grafting (CABG) at our hospital. During mediastinal exploration and pericardiotomy for CABG, a large CTC was incidentally found in the retrocaval position, as a watery cyst from its anatomic location and content. Pathological examination revealed that it was a CTC. No cases of retrocaval position of CTC have been reported. Thus, here we report on this case and review the previously reported cases..
    Conclusions
    To our knowledge, this is the first case of CTC that was identified incidentally in the retrocaval position and caused intermittent obstruction of vena cava..
    Keywords: Coronary Artery Disease, Cronary Artery Bypass, Cyst
  • Fatemeh Azarkish, Khadijeh Mirzaii Najmabadi *, Robab Latifnejad Roudsari, Fatemeh Homaei Shandiz Page 8
    Background
    Most women are diagnosed with breast cancer (BC) when they are still at the appropriate age for employment. The increasing survival rates of patients with BC call for more attention to their ability to return to work..
    Objectives
    The aim of this study was to identify factors related to the return to work in Iranian women underwent BC treatment..Patients and
    Methods
    A total of 175 women with BC, who met the inclusion criteria, were enrolled in this cross-sectional study. The subjects were recruited from four hospitals affiliated to Mashhad university of medical sciences. These hospitals are oncology referral centers in eastern Iran. All records of employed women with BC were studied in four hospitals of Mashhad city, Iran, during 2000 - 2010. The researchers designed a questionnaire, which consisted of questions regarding social/demographic, health/disease, and work characteristics. The questionnaires were completed through interviews. Data were analyzed using SPSS software, version 11.5..
    Results
    The mean age of the patients at the time of interview was 44.3 ± 6.72 years. Mean age of “Return- to-work” group was 42.71 and “No return-to-work” group was 51.06. Most women (80%) were married. At the time of the interview, 80% had returned to work after a BC diagnosis. Older patients (OR = 0.796; 95% CI, 0.625 - 0.907, P = 0.002), and those with a great deal of work experience (OR = 0.861; 95% CI, 0.752 - 0.986, P = 0.030) were less likely to return to work. Also, women who had no pain or surgery scar (OR = 23.03; 95% CI, 4.53 - 117.02, P < 0.001) as well as those who had no lymphedema after the BC treatment were more likely to return to work (OR = 22.373; 95% CI, 4.04 - 23.892, P < 0.001)..
    Conclusions
    The results of this study show the factors related to the return-to-work after BC treatment in working women in Mashhad city, Iran. These predictors should be taken into account in order to improve the patient’s life quality..
    Keywords: Return to Work, Breast Cancer, Women, Iran
  • Shirin Fahimi, Mohammad Abdollahi, Seyed Alireza Mortazavi, Homa Hajimehdipoor *, Amir Hossein Abdolghaffari, Mohammad Amin Rezvanfar Page 9
    Background
    Burns are known as one of the most common and destructive forms of injury with a vast spectrum of consequences. Despite the discovery of various antibacterial and antiseptic agents, burn wound healing still has remained a challenge to modern medicine. Plants, with a valuable traditional support, have been considered as potential agents for prevention and treatment of disorders in recent years. However, modern scientific methods should be applied to validate the claims about the therapeutic effects of the herbal products..
    Objectives
    This study was conducted to evaluate the wound-healing activity of a poly herbal cream (PHC), retrieved from Iranian Traditional Medicine (ITM), in a rat burn wound model in Iran..
    Materials And Methods
    In this experimental study, PHC containing aqueous extracts of Malva sylvestris and Solanum nigrum leaves and oily extract of Rosa damascena petals was used. Second-degree burn wounds were induced in four groups of five rats each. Group 1 received no treatment while groups 2, 3 and 4 were given cream base, silver sulfadiazine (SS) 1% and PHC, respectively to compare the efficacy of PHC with the negative and positive control groups. The percentage of wound healing on days 2, 6, 10 and 14 and histopathological parameters of healed wounds on the 14th day were assessed. Antioxidant and antimicrobial activities of PHC were evaluated using 2, 2-diphenyl-1-picrylhydrazyl (DPPH) and micro-dilution methods, respectively..
    Results
    There was a significant improvement in healing percentage of PHC-treated rats in comparison to the other groups at the end of the treatment period (87.0% ± 2.1% for PHC in comparison to 32.2% ± 1.6%, 57.0% ± 5.3% and 70.8% ± 3.5% for the control, cream base and SS groups, respectively). Moreover, the healed wounds in PHC-treated animals contained less inflammatory cells and had desirable re-epithelialization with remarkable neovascularization. In addition to the antioxidant activity, PHC exhibited antibacterial effect against Staphylococcus aureus..
    Conclusions
    Poly herbal cream experimentally and histopathologically revealed a burn wound healing activity probably due to the antioxidant, anti-inflammatory and antimicrobial activities of its phytochemical contents. Therefore, this study confirms the use of M. sylvestris, S. nigrum and R. damascena in burn prescriptions in ITM..
    Keywords: Burn Wound Healing, Iranian Traditional Medicine (ITM), Malva sylvestris, Rosa damascena, Solanum nigrum
  • Farzad Mehrabi, Ali Asgari * Page 10
    Background
    Despite all advances in neurological sciences, there are unknown aspects in the epidemiology of multiple sclerosis (MS). Based on this hypothesis, the enterotoxigenic strains of Staphylococcus aureus (S. aureus) are possible risk factors for exacerbations of MS..
    Objectives
    The present study was carried out to investigate the role of resistant strains of enterotoxigenic S. aureus in MS exacerbation..
    Materials And Methods
    Two-hundred nasal swab samples were collected from non-MS (n = 80), MS stable (n = 60) and MS exacerbation (n = 60) groups. Samples were cultured and those that were S. aureus-positive were analyzed for the presence of enterotoxins, using polymerase chain reaction (PCR). Antimicrobial susceptibility was performed using disk diffusion method..
    Results
    Ninety out of 200 nasal samples (45%) were positive for S. aureus. The highest levels of nasal colonization were seen in MS exacerbation group (68.33%). The most commonly detected enterotoxins were sea (30%), sec (15.55%) and seb (11.11%). There were significant differences between S. aureus colonization and type of samples (P = 0.026) and, also, between type of samples and prevalence of enterotoxins (P = 0.022). The highest levels of enterotoxigenic genes were seen in MS exacerbation group. The S. aureus strains had the highest levels of resistance against tetracycline (80%), ampicillin (72.22%), methicillin (66.66%), erythromycin (66.66%), oxacillin (63.33%), trimethoprim-sulfamethoxazole (61.11%) and cotrimoxazole (55.55%)..
    Conclusions
    Our findings should raise awareness about the role of sea and sec enterotoxins, in resistant strains of S. aureus, as a risk factor for MS exacerbation. It is better to keep MS patients away from polluted environments of hospitals and health centers..
    Keywords: Multiple Sclerosis, Antibiotic Resistance, Iran, Enterotoxins, Staphylococcus aureus
  • Ali Fakhr-Movahedi, Mohsen Soleimani *, Razeyeh Ghazvininejad, Mohammad Kazem Maher, Raheb Ghorbani Page 11
    Background
    Coronary artery diseases (CAD) are associated with psychological problems such as anxiety and depression in patients. Thus, management of these problems can consider as an important intervention by health care workers, especially nurses..
    Objectives
    The purpose of this study was to investigate the effectiveness of patient-focused clinical pathway on anxiety, depression and satisfaction of patients with CAD..Patients and
    Methods
    In this quasi-experimental study, 138 patients suffering from CAD in a coronary care unit of a referral teaching hospital affiliated to Semnan University of Medical Sciences in Semnan, Iran, were recruited using a convenience sampling method. The participants were assigned to two groups: Clinical pathway (CP) and routine (RUT) care. The level of anxiety and depression of patients were measured in admission and discharge in both groups. Also, the level of patients’ satisfaction was measured at the time of discharge. Data were analyzed using descriptive and inferential statistics..
    Results
    Prevalence rates of anxiety and depression in total of patients were 7.2% and 8.7%, respectively. In terms of anxiety, the mean of difference between pretest and posttest scores in the CP group (0.52 ± 1.39) was higher compared to the RUT group (-0.17 ± 1.69) and there was a significant difference between the two group (P = 0.009). In terms of depression, the mean of this difference in the CP group (0.75 ± 2.05) was higher compared to the RUT group (0.00 ± 1.08), as there was a significant difference between the two group (P = 0.024). Also, the mean of patients’ satisfaction scores in the CP group (3.69 ± 0.39) was higher compared to the RUT group (3.45 ± 0.47) and there was a significant difference between the two groups (P = 0.002)..
    Conclusions
    According to the positive effects of CP on patients with CADs, it can be considered as a useful, safe and simple instrument for the improvement of patients’ outcomes. Thus, the findings of this study can provide a new insight in patient care for clinical nurses..
    Keywords: Coronary Artery Disease, Patient Satisfaction, Anxiety, Depression, Clinical Pathways
  • Sema Tanriverdi *, Zulal Ulger, Betul Siyah Bilgin, Nilgun Kultursay, Mehmet Yalaz, Yuksel Atay, Ozge Altun Koroglu Page 12
    Introduction
    Neonatal lupus syndrome (NLS) is a passively acquired autoimmune condition due to the transplacental passage of maternal anti-Ro/SSA and anti-La/SSB antibodies in mothers with systemic lupus erythematosus (SLE), and congenital complete heart block (CHB) is its most serious manifestation. Skin and hepatic involvement may occur in later infancy..
    Case Presentation
    A term infant with fetal bradycardia, detected at the 23rd gestational age, was diagnosed with CHB due to NLS and was successfully treated with a permanent epicardial pacemaker. The patient was reported here due to rarity of the procedure in neonatal period..
    Conclusions
    Mothers with SLE should be screened and closely followed up during pregnancy for the development of fetal atrioventricular (AV) block..
    Keywords: Heart Block, Neonatal Lupus Syndrome, Artificial Cardiac Pacemaker, Therapy
  • Majid Mobasseri, Shahram Ghiyasvand, Alireza Ostadrahimi, Morteza Ghojazadeh, Hamid Noshad *, Samira Pourmoradian Page 13
    Background
    Type 2 diabetes is the fourth major public health problem worldwide. Royal Jelly (RJ) insulin-like activity and blood glucose modulating properties have been reported in animal and healthy volunteers..
    Objectives
    This study aimed to investigate the effect of a single dose of fresh RJ as a complementary therapy on glycemic response in patients with type 2 diabetes..Patients and
    Methods
    In this randomized clinical trial, 40 patients with type 2 diabetes were assigned into the RJ (n = 20) and placebo (n = 20) groups and received either 10 g fresh RJ or placebo after overnight fasting. Serum glucose, insulin and C-peptide concentrations were determined at 0, 60, 120 minutes after the intervention. Independent t-tests and repeated measures ANOVA were used to analyze data..
    Results
    The mean serum glucose levels were significantly decreased in RJ and placebo groups; however, mean serum level was different but not statistically. (P = 0.77). One hour after RJ ingestion the mean serum insulin concentrations were increased and after 2 hours it was decreased insignificantly (P = 0.54, P = 0.20). The mean C-peptide concentrations were significantly increased after 1 and 2 hours of RJ ingestion; however, in the placebo group we observed a slight but insignificant reduction at the time of 1 and 2 hours in the mean C-peptide serum levels (P = 0.40). Moreover, there was no significant difference in none of the glycemic control parameters between both studied groups (P > 0.05)..
    Conclusions
    It seems that RJ does not appear to have significant immediate effects on glycemic factors in patients with type 2 diabetes. However, further studies with larger sample sizes and different doses of RJ are needed to achieve more precise results..
    Keywords: Royal Jelly, Hyperglycemia, Glycemic Control
  • Forough Mortazavi, Saideh S. Mortazavi, Razieh Khosrorad * Page 14
    Background
    Procrastination is a common behavior which affects different aspects of life. The procrastination assessment scale-student (PASS) evaluates academic procrastination apropos its frequency and reasons..
    Objectives
    The aims of the present study were to translate, culturally adapt, and validate the Farsi version of the PASS in a sample of Iranian medical students..Patients and
    Methods
    In this cross-sectional study, the PASS was translated into Farsi through the forward-backward method, and its content validity was thereafter assessed by a panel of 10 experts. The Farsi version of the PASS was subsequently distributed among 423 medical students. The internal reliability of the PASS was assessed using Cronbach’s alpha. An exploratory factor analysis (EFA) was conducted on 18 items and then 28 items of the scale to find new models. The construct validity of the scale was assessed using both EFA and confirmatory factor analysis. The predictive validity of the scale was evaluated by calculating the correlation between the academic procrastination scores and the students’ average scores in the previous semester..
    Results
    The corresponding reliability of the first and second parts of the scale was 0.781 and 0.861. An EFA on 18 items of the scale found 4 factors which jointly explained 53.2% of variances: The model was marginally acceptable (root mean square error of approximation [RMSEA] =0.098, standardized root mean square residual [SRMR] =0.076, χ2 /df =4.8, comparative fit index [CFI] =0.83). An EFA on 28 items of the scale found 4 factors which altogether explained 42.62% of variances: The model was acceptable (RMSEA =0.07, SRMR =0.07, χ2/df =2.8, incremental fit index =0.90, CFI =0.90). There was a negative correlation between the procrastination scores and the students’ average scores (r = -0.131, P =0.02)..
    Conclusions
    The Farsi version of the PASS is a valid and reliable tool to measure academic procrastination in Iranian undergraduate medical students..
    Keywords: Validation Studies, Students, Education, Medical, Undergraduate
  • Jamal Seidi, Fatemeh Alhani *, Mahvash Salsali Page 15
    Background
    Clinical judgment development is necessary because it leads to appropriate nursing diagnoses, clinical decision-making and health promotion..
    Objectives
    In this study we explored the process of Iranian nurses’ development in clinical judgment..Patients and
    Methods
    This qualitative study was conducted in 2013 at hospitals of Kurdistan University of Medical Sciences, located in the Sanandaj city of Iran. The data were collected based on semi-structured interviews and the study included 24 participants. Data analysis was carried out concurrently with data collection using the grounded theory method..
    Results
    The study participants’ main concern was ‘being non-professional in clinical judgment’. In response to this concern, they were struggling for gaining professional autonomy, striving for integrating clinical judgment skills, scrambling to make effective educational interventions and striving for professional and inter professional collaboration in clinical judgment. The core category was ‘struggling for becoming professional in clinical judgment development’. When nurses were supported professionally, they were able to develop their professional clinical judgment..
    Conclusions
    The findings of this study provided critical information about nurses’ professionalization in clinical judgment. Accordingly, the participants adopted different strategies to develop their clinical judgment ability. Integrating these strategies into nursing theory and clinical education can improve nurses’ clinical judgment ability..
    Keywords: Judgment, Nurse, Qualitative Research, Iran
  • Ilker Ilhanli *, Necip Guder, Murat Gul Page 16
    Background
    Despite the insufficient evidence, due to potential contribution to the improvement, platelet-rich plasma (PRP) is emerging as a promising method..
    Objectives
    The aim of this study was to assess the effectiveness of PRP injection in partial supraspinatus tears by comparing with physical therapy (PT)..Patients and
    Methods
    Seventy patients with chronic partial supraspinatus tears in magnetic resonance imaging were randomized into two groups; PRP (n = 35) and PT (n = 35). Before the treatment, at the end of the treatment and at the 12th month after the end of the treatment, range of motion (ROM), visual analog scale (VAS) for pain, Disabilities of Arm, Shoulder and Hand questionnaire (DASH), Neer’s, Hawkins’ and drop arm tests and Beck Depression Inventory were investigated..
    Results
    Statistical analysis was made for 62 subjects (PRP group, n = 30; PT group, n = 32). There were no differences between the groups according to demographic data. At the 12th month after the end of the treatment, significant improvement in ROM was detected in both groups, pain was reduced significantly in both groups and improvement of the DASH score was observed in both groups. At all the evaluation steps, increases in ROM degrees were significantly higher in the PT group than the PRP group. For VAS in activity and in rest, after the treatment, improvement was higher in the PT group than the PRP group. However, improvement of the DASH score of the PRP group was significantly better than the PT group..
    Conclusions
    When we compared with PT, PRP seemed to be a well-tolerated application which showed promising results in patients with chronic partial supraspinatus tears..
    Keywords: Platelet, Rich Plasma, Shoulder, Tear