Chronic Diseases Journal
Volume:2 Issue: 2, Summer-Autumn 2014

Nursing errors are common in critical care units while most of them are preventable. Critical care nurses are uniquely positioned to prevent the recurrence of nursing errors. The purpose of this study was to explore the strategies considered or used by nurses in order to prevent the recurrence of nursing errors in chronic critical care units. A qualitative design using content analysis method was employed in the present study. In-depth interviews were conducted with a sample of 17 participants, recruited through purposive sampling. This study was conducted in 2011-2012 in Iran. Results indicated that the strategies used by critical care nurses to prevent recurrence of nursing errors include personal strategies (paying more attention, updating information, reminding and hinting, experience sharing, prevention), and expectations from the organization (increasing intrinsic motivation and decreasing work pressure). Nursing administrators must be aware of the individual strategies used by the nurses to develop and promote their implementation and underlying these strategies. Identifying and understanding the strategies used by nurses can help them in their support provision. Explored strategies can be used to develop interventions for prevention of nursing errors. Further exploration of the question of how the nursing context will influence strategy selection and why is necessary. Regarding the strategies used by nurses, nurse managers must utilize them in planning in order to develop an error free care.

Differentiation of stable angina from unstable angina is important because they need different approaches. Few studies have been conducted to assess the diagnostic value of high sensitive C-reactive protein (hs-CRP) in differentiating these two diseases. This study aimed to evaluate the diagnostic value of hs-CRP levels for differentiating stable angina from unstable angina. After signing the consent form, patients with unstable angina who referred to Tohid Hospital emergency in Sanandaj, Iran, and patients with stable angina who referred to the special clinic of the hospital were evaluated. Disease was confirmed by a cardiologist. Morning serum hs-CRP was tested using MONOBIND laboratory kit (USA). Data were analyzed by SPSS using Student’s independent t-test, Mann-Whitney U, chi-square, Fisher exact test, and receiver operating characteristic curve. hs-CRP levels in patients with stable angina and unstable angina were 1.6 (± 1.18) and 2.35 (± 1.30) mg/l, respectively (P = 0.025). The hs-CRP level ≥ 2.31 mg/l was the best cut-off point for differentiating stable from unstable angina. At this cut-off point, the sensitivity and specificity were 56% and 73%, respectively. Area under the curve was calculated to be 0.679 (95% confidence interval: 0.54-0.81) (P = 0.017). hs-CRP level is helpful for differentiating patients with stable angina from those with unstable angina. It is recommended to consider the hs-CRP level of 2.31 mg/l as the best cut-off point.

Rheumatoid arthritis (RA) is the most common chronic disease involving joints. Anti-cyclic citrullinated peptide (anti-CCP) as a specific antibody is a reliable index to early diagnosis of RA. Disease-modifying anti-rheumatic drugs (DMARDs) can reduce progression of RA joint destruction. The present study aimed to investigate the effects of DMARDs in reducing serum anti-CCP. A cross-sectional study was performed on 30 patients including 22 females and 8 males RA patients according to the American College of Rheumatology (ACR) classification criteria, who referred to the Rheumatology Clinic. Treatment with DMARD group started at the beginning of the study (May 2009). At 1st and 6th month of the study, clinical findings and disease activities were recorded and anti-CCP was measured. At the beginning and the end of the study, morning stiffness for more than 1 h and involvement of three areas were, 28 (93%) and 12 (40%), respectively. Indicators of disease severity in patients, the mean ± SD serum levels of erythrocyte sedimentation rate at the beginning and end, were 40.7 (30-59) mm/1 h and 13.4 (9-86) respectively. Anti-CCP at the beginning and end of the study was 141.83 (65.8-101.09) U/ml and 65.8 (62-92) U/ml respectively (P < 0.05). Disease Activity Score in 28 joints and rheumatoid factor positive and C-reactive protein positive were significantly different at the onset and at the end of the study (P < 0.05). Measurement of serum anti-CCP is a helpful index of treatment response and monitoring of treatment efficacy in patients with RA.

Diabetic retinopathy (DR) is one of the complications occurs in patients with diabetes mellitus (DM) and is the leading cause of new onset blindness. This study aimed to determine the possible association between plasma homocysteine (Hcy) levels and the development and progression of DR. This case-control study enrolled diabetic patients who referred for ocular consultation from the Diabetes Clinic of Tohid Hospital in Sanandaj, Iran, in 2013. Patients with type 2 DM (n = 156) were randomly assigned to evaluate the association between Hcy and DR. Participants were randomly divided into two groups; with or without DR. Patients in both groups were matched for confounding factors. Detection and grading of retinopathy was performed by indirect ophthalmoscopy and fluorescein angiography. Glycosylated hemoglobin (HbA1c) was measured by Enzyme-linked Immunosorbent Assay and fasting plasma Hcy levels measured by chromatography. Plasma Hcy more than 15 µmol/l was defined as hyperhomocysteinemia. The results showed that there were no significant differences in Hcy levels in diabetic patients with or without retinopathy. Also, we found that there was no association between HbA1c level and plasma Hcy. In addition, data analysis indicates that no association was observed between disease duration and Hcy levels. In conclusion, we found that there was not a significant association between plasma Hcy level and DR in patients with type II DM.

Asthma is the most common chronic disease of childhood that causes disturbance in the physical, emotional, mental health, and different information has been mentioned on its risk factors, including factors associated with birth. Therefore, in this study, the relationship between children asthma and factors associated with birth was studied. This case-control study was performed on 50 children with asthma as the case group and 150 children hospitalized without asthma as the control group (after matched for age and sex) in an age range of 4-14 years old. Information required on factors affecting asthma was recorded for both groups. Data analysis was performed using SPSS for Windows software. The results of this study showed that the majority of children in the case group were males born through cesarean operation (C-section). A significant difference was seen between two groups in terms of factors such as preterm [odds ratio (OR) = 3.27, confidence interval (CI) 95% = 1.57-6.81] and family history of asthma (OR = 8.50, CI 95% = 4.10-17.60). Regression model of relational variables with asthma show that the family history of asthma was most effective determinant on birth-related factors of asthma. The findings of this study showed that positive family history of the disease and premature-birth in infant correlates significantly and directly with asthma occurrence in children. Thus, it is recommended to make further follow-ups in providing prenatal care and early diagnosis of the disease.

Fahr syndrome which presents with various signs and symptoms has a familial predisposition and is characterized by symmetric calcification of basal ganglia. It may present with neuropsychiatric, extrapyramidal, and cerebellar symptoms. The etiology has not been defined yet. A 38-year-old woman referred to the psychiatric clinic of 5th Azar Hospital, Gorgan, Iran, with neuropsychiatric presentation.

Wolfram syndrome (WFS) is a rare disease inherited as an autosomal dominant trait. Type I diabetes mellitus and optic atrophy are the main symptoms of the disease. It is also known as DIDMOAD syndrome due to the association of diabetes insipidus, diabetes mellitus, optic atrophy, and deafness. WFS may be associated with other disorders such as kidney failure, gonadal atrophy, and mental and behavioral disorders. This report is about a 14-year-old teenager who had suffered from vision loss and cataracts when he was 4 years old. At the age of 7 he has been diagnosed with type I diabetes mellitus due to polyuria and polydipsia. At the age of 12 he developed diabetes insipidus, neural hearing loss, urinary incontinence and bilateral hydronephrosis, neurogenic bladder, and increased blood pressure. Physicians should think of this disease and recommend genetic counselling before marriage.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a genetic disorder and assessment of newborns with or without this deficiency is an essential component in public health evaluation in different countries. Hence, this study was aimed to assess the prevalence of G6PD deficiency in the newborn population in Sanandj, Iran. This is a cross-sectional study on 2016 newborns in Besat Hospital in Sanandaj, Iran, in the year 2006. Three drops of blood were collected from the infants’ heels using sterile needles. Then fluorescent spot test was utilized to study the activity of G6PD enzyme. The results of the present study conducted on 2016 neonates showed that 48.80% (984) of them were males and 51.20% (1032) were females. Prevalence of G6PD deficiency in boys and girls were 7.62% and 2.52%, respectively with a male to female ratio of 3:1. G6PD deficiency is a gender related condition with a higher frequency among boys’ population.