فهرست مطالب

  • Volume:21 Issue: 20, 2020
  • تاریخ انتشار: 1399/05/19
  • تعداد عناوین: 8
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  • Saeed Shahabi, Kamran Bagheri Lankarani * Page 1
  • Kobra Salehi, Farimah Shirani, Vajihe Atashi *, Somayeh Ghafari Page 2
    Background

    Respecting inherent human dignity has a prominent role and is of great importance in health care discussions. Respect for people’s dignity is the basis of nursing care and is a step toward increasing patients’ satisfaction with the services provided by the staff.

    Objectives

    The present study aimed to investigate the relationship of respect for dignity with anxiety, depression, stress and quality of life in patients with heart failure.

    Methods

    This is a descriptive analytic study. The study population consisted of the patients with heart failure hospitalized at Isfahan University of Medical Sciences from 2017 to 2018. In this research, samples were selected through purposive sampling, consisting of 150 patients with heart failure from the research population. Then personal characteristics questionnaire, Inherent Dignity questionnaire (IDQ), Minnesota Living with Heart Failure questionnaire (MLHF), as well as Depression, Anxiety, Stress scale (DASS) were completed by samples. Statistical analysis was performed using descriptive statistical methods, Pearson’s correlation coefficient, one-way ANOVA and independent t-test.

    Results

    The mean total score for patients’ inherent dignity was 102.21 out of 144, with a standard deviation of 17.92. Pearson correlation coefficient showed that the total score of the patients’ inherent dignity had no significant relationship with age (P = 0.57) and the number of heart failure-related hospital admissions (P = 0.71). Pearson correlation coefficient showed that the total score of the patients’ inherent dignity had an inverse relationship with their scores of the quality of life (P = 0.002), depression (P = 0.004), anxiety (P = 0.001), and stress (P < 0.001).

    Conclusions

    Considering the fact that nowadays the improvement of service quality is one of the priorities of healthcare and, on the other hand, as research findings show, respecting the dignity of heart failure patients plays an important role in reducing stress, anxiety, and depression as well as increasing the quality of life, these results can be used in planning to support and improve the treatment, and the care provided for patients, and to guide the future researches regarding the inherent dignity of these patients.

    Keywords: Anxiety, Depression, Stress, . Dignity, the Quality of Life
  • Parviz Saleh, Sepehr Taghizadeh, Reza Piri, Sahar Mohammadi, Mohammad Naghavi Behzad *, MohammadMirza Aghazadeh Attari * Page 3
    Background

    Influenza viruses are classified into three types of A, B, and C, with H1N1 being a member of the influenza A subtype. The majority of people infected with influenza, namely H1N1, exhibit self-limited, uncomplicated, and acute febrile respiratory symptoms, or are asymptomatic. However, severe disease and complications due to infection, including hospitalization and death may occur. One of the most prominent features of influenza infections are radiologic findings in chest X-rays, computed tomographic scan, and angiographies.

    Methods

    In a descriptive-analytical study, all patients who were diagnosed with H1N1 at the Sina Educational-Medical Center of Tabriz University of Medical Sciences (Tabriz, Iran) from September 2015 to September 2016 were analyzed based on age, clinical presentation, and radiological findings.

    Results

    A total of 53 cases, 30 females (57%) and 23 males (43%), were included in the study. The mean age was 48.45 ± 1.7. The most common clinical presentation was myalgia (92.5%). Chest X-ray (CXR) was done in all patients, 35 cases (66%) were found with bilateral abnormality, 11 cases (20.8%) without abnormality, and seven cases (13.2%) with unilateral abnormality. Chest computerized tomography (CT) scan was also done on all patients, 33 cases (62.2%) were found with bilateral abnormality, 17 cases (32%) without abnormality, and three cases (5.6%) with unilateral abnormality. CT angiography was done in eight patients; none of the patients showed any signs of pulmonary embolism. It was observed that CXR and CT-scan were both precise in studying radiological findings in H1N1.

    Conclusions

    The majority of patients had revealed bilateral abnormality in radiographic findings, and unilateral involvement was less common; in addition, involvement in the superior lobes of the lungs were more common than the basal lobes. CXR and CT scans had no significant difference in diagnosing the disease.

    Keywords: H1N1, Radiological Findings, Chest X-Ray
  • Valiollah Hassani, Seyed HamidReza Faiz, Poupak Rahimzadeh, Nasim Nikoubakht *, Mohammad Ghaemi, Azadeh Sayarifard Page 4
    Background

    Postoperative pain has many adverse effects and if not properly controlled, it can cause a wide range of problems.

    Objectives

    The purpose of this study is to compare the results of using ketamine and apotel infusion pumps to control pain after posterior fusion surgery.

    Methods

    In this clinical trial study, 72 patients hospitalized for posterior spine fusion surgery were randomly assigned into two groups, including ketamine infusion pumps (ketamin group) and apotel infusion pumps (apotel group). In the ketamin group, 0.2 mg/kg/h of ketamine was infused to by a pain pump with normal saline to 100 cc. In the apotel group, apotel was used instead of ketamine. The rate of pain was evaluated in recovery, and at 6, 12, 18, 24, and 48 hours after the surgery, based on VAS criteria. The rate of sedation was recorded based on Ramsy score.

    Results

    There was no significant difference between age, sex, BMI, underlying diseases, and smoking in patients with posterior spinal fusion surgery between the groups. Postoperative pain score was significantly lower in the patients with posterior fusion surgery at 6, 12, 18, 24, and 48 hours in the ketamin group compared to the apotel group (P < 0.001). Patients’ satisfaction with the analgesia was significantly higher in the patients at 24 hours (P = 0.001) and 48 hours (P = 0.04) in the ketamine group compared to the apotel. With regards to the Ramsy scores of the patients with posterior fusion surgery, there was no significant difference between the groups (P = 0.16).

    Conclusions

    The use of a ketamine infusion pump can be more effective than an apotel infusion pump to control pain after posterior fusion surgery.

    Keywords: Spinal Fusion, Paracetamol, Ketamine Hydrochloride
  • Hesam Seyedin, Mahnaz Afshari *, Parvaneh Isfahani, Kobra Sharifkazemi, Malihe Morshedi, Amin Akbari Page 5
    Background

    The health transformation plan (HTP) was implemented in April 2014 in university hospitals to provide equitable access to healthcare, improve the quality of care, and protect patients against high costs of hospitals.

    Objectives

    The present study aimed to investigate out of pocket (OOP) payment by inpatients after the health sector evolution plan (HSEP) and its effective factors in hospitals affiliated with Iran University of Medical Science.

    Methods

    In this study, descriptive and cross-sectional research design was utilized. 277 patients at 5 hospitals affiliated with Iran University of Medical Sciences were selected via simple random approach. Checklists and hospital bills were used to collect data. Then the data were analyzed by SPSS 19.0.

    Results

    The results indicated that OOP was 18.71% of the total hospitals expenditure. There was a significant relationship among insurance status, location, and OOP (P < 0.05).

    Conclusions

    The OOP rate of hospitalized patients was not in accordance with the goal set in the HSEP. Thus, policymakers and managers should take serious measures to decrease out-of-pocket payments.

    Keywords: Hospital, Health Expenditures, Inpatients, Out-of-Pocket
  • Parisa Tandel, Eqbal Ebrahimi, Mani Ramzi, Alireza Rezvani, Reza Ranjbaran, Gholamhossein Tamaddon* Page 6
    Background

    Acute myeloid leukemia is a type of hematological malignancy. Chemotherapy is the first-line treatment for AML. The main aim of treatment is to achieve complete remission in patients. Although complete remission is achieved in most patients, still the rate of relapse remains high. Recent studies revealed that drug resistance is an important cause of treatment failure in AML patients. Autophagy as a conserved catabolic process has a significant role in drug resistance of AML. Autophagy can act as a chemo-resistance mechanism in response to chemotherapy in AML patients. However, the role of this pathway in response to treatment of AML patients is not yet fully clarified.

    Objectives

    The aim of this study was to investigate the effect of the BECN1 gene, as a key regulator of autophagy on remission and response to chemotherapy in AML patients.

    Methods

    The BECN1 gene expression was evaluated in 30 AML patients at diagnosis stage, on 18 patients with complete remission and 15 controls using qRT-PCR.

    Results

    The results showed that BECN1 gene expression level was significantly higher in AML patients than controls at the rate of 5/3 fold, P < 0.0001. We found that expression level of BECN1 was significantly reduced in patients with complete remission in comparison with newly diagnosed AML patients at the rate of 0.73 fold, P = 0.004.

    Conclusions

    Low expression of BECN1 gene might be associated to complete remission. Therefore, perhaps BECN1 gene can be used as a biomarker to assess remission status. Moreover, targeting BECN1 can be used as a potential strategy to improve treatment in AML patients.

    Keywords: Autophagy, Acute Myeloid Leukemia, BECN1, Complete Remission
  • Yazdan Ghandi*, Danial Habibi, Aziz Eghbali Page 7
    Background

    Cardiac involvement in beta-thalassemia major patients is an important cause of mortality. Therefore, in these patients, timely diagnosis of cardiac disorder is essential.

    Objectives

    The present study aimed at determining the association between cardiac iron overload and fragmented QRS (fQRS).

    Methods

    This cross-sectional study was conducted on 40 β-TM patients, aged 5 - 40 years. The presence of fQRS was evaluated in 12-lead surface electrocardiograms. Cardiac T2* MRI was performed to determine the iron overload. The patients were divided into four groups of chelation therapy.

    Results

    The mean age of patients was reported to be 22.50 ± 6.75 years. The groups showed no significant difference regarding gender, age, or left ventricular ejection fraction. The presence of fQRS was detected in 10 patients (25%), while T2* value was lower than 20 ms in 10 patients (25%). The mean age of patients with and without fQRS was 26.23 ± 2.71 and 19.40 ± 2.61 years, respectively (P = 0.001). The univariate analysis indicated that fQRS had a significant relationship with cardiac iron overload (OR = 5; 95% CI: 1.04 - 23.99; P < 0.044). The multiple logistic regression analysis represented a significant association between iron overload and fQRS (OR = 5.556; 95% CI: 1.027 - 30.049). The sensitivity and specificity of the fQRS against MRI were equal to 50% and 83.3% respectively.

    Conclusions

    The absence of fQRS on ECGs could be a good predictor of the lack of cardiac iron overload in β-TM patients. The results showed that fQRS might indicate the no need for close monitoring for cardiac overload with cardiac MRI and aggressive chelation therapy.

    Keywords: Electrocardiography, Beta-Thalassemia Major, Cardiac MRI, Fragmented QRS, T2% Value
  • Tayebeh Rakhshani, Diba Raooufi, Hassan Hashemi, Zahra Motlagh * Page 8

    Dear Editor, Quality of service is recognized as a key determinant of an organization's success and any decline in customer satisfaction due to poor service quality causes concern. Among the service sub-sectors, the health sector has a special place because any mistake, even the smallest one, is not allowed in this section (1). Protecting the community is the task of this sector and effective action is particularly important to improve customer service and customer satisfaction in this sector (2). Evidence shows that there is a relationship between the quality of medical services and patient satisfaction. According to Parasuraman et al. study, service quality is a comparison between expectation and performance, and service providers must compare expected and perceived services to understand the quality and identify of the gaps between expected and perceived data on service quality (3). One of the most commonly used comprehensive methods to assess the quality of expected and perceived services is the SERVQUAL model (4). Given that one of the most important groups in assessing the quality of health care services is clients, this study aimed to assess the quality of healthcare services using SERVQUAL Approach in Ahwaz Health centers. This cross-sectional study was conducted in Ahwaz in 2016. The study population consisted of the people under the coverage of the Health centers in the west of Ahwaz City who were selected via quota sampling method. Using the Cochran formula, the sample size was determined to be 384 persons. The data were collected using the SERVQUAL questionnaire developed by Parasuraman et al. This questionnaire has 22 questions and 5 dimensions: physical and tangible dimension (4 questions), reliability (5 questions), responsiveness of service providers (4 questions), service assurance (4 questions), and staff empathy (5 questions). The questionnaire was used in two stages. The score of total quality varied from 1 to 7. The validity and reliability of this questionnaire were confirmed by Zarei et al. (5, 6). The data analysis was conducted using the SPSS 16 software, paired t-test, t-test, and ANOVA. The significance level was considered lower than 0.05. The highest percentage of the subjects were in the age group of 18 - 29 years. Moreover, 328 (85.4%) were female and 56 (14.6%) were male. Based on the findings of the study, there were differences between the mean score of perception and expectation in all dimensions of quality: tangibility (-0.6), reliability (-0.53), responsiveness (-0.73), assurance (-0.66), empathy (-1.04), overall quality (-0.68) (P < 0.0001). No significant difference was found between perceptions and gender (P = 0.30) and expectations and gender (P = 0.30). According to the one-way analysis of variance (ANOVA), no significant difference was found between perceptions and variables of age (P = 0.272) and education level (P = 0.354) and between expectations and variables of age (P = 0.171) and education level (P = 0.457). The study results indicated that there were general quality differences in all five service dimensions, and the differences were negative. This result was consistent with similar studies (7, 8). The highest quality difference in the present study was observed in the empathy dimension. In one meta-analysis in which Teshnizi et al. (9) aimed to assess the quality of health services in Iran, tangibility and empathy had the largest gaps. Since dissatisfied patients are less likely than other patients to comply with medical instructions and the process of recovery is slower than others, medical centers need to continually evaluate the quality of their services. Furthermore, given that the highest difference in service quality was observed in the empathy dimension, it seems essential to hold workshops in order to polish employees’ communicative skills.