Iranian Red Crescent Medical Journal
Volume:23 Issue: 12, Dec 2021

Coronavirus disease 2019 (COVID-19) has made the grief process more complicated and brought about loads of unexpressed grief.

The present study aimed to determine the severity of grief reactions following the death of first-degree relatives (FDRs)due to COVID-19.

This analytic cross-sectional study was conducted to determine the grief score of people aged over 18 with the experience of losing one of their FDRs (i.e., father, mother, and siblings) due to COVID-19. Convenience sampling wasemployed to select the participants. The instrument used in this study was the Grief Experience Questionnaire (GEQ-34) which was completed via phone calls. The inclusion criteria entailed a willingness to participate in the study, the age range of above 18, and experience of FDR’s death. On the other hand, the exclusion criteria were severe discomfort and restlessness while talking on the phone. Descriptive statistics and multiple linear regression were employed to diagnose the factors affecting grief using SPSS software (version 22) with a significance level of 0.05.

The findings indicated that the mean score of GEQ was 67.22±19.24(ranging from 34 to 126). In this study, 54.5%, 40.2%, and 5.3% of subjects experienced low, moderate, and severe levels of grief, respectively. The grief score showed a positive relationship with the gender of the mourners and marital status; nonetheless, it was negatively correlated with subjects’ employment and the age of theirdeceased FDRs.

As evidenced by the obtained results, among the subscales of mourning, the highest scores were related to the dimensions of justification, coping, and guilt. Communication and social support were reduced due to the COVID-19 pandemic; therefore, the provision of online mental health services can be a useful way to treat and help the bereaved.

To detect the health‐related quality of life (HRQoL) of Thyroid cancer (TC) patients and analyze the change tendency of TC patient’s reported symptoms after surgery.

A total of 102 TC patients who underwent thyroid surgery from September 2020 to January 2021 were enrolled in this study, and received a survey on HRQoL (EORTC QLQ-C30) and disease-specific symptoms (THYCA-QoL) at 1 month and 3 months after surgery.

Almost all the patients experienced TC specific symptoms after surgery. At 1 month after surgery, throat/mouth problems, voice problems, neuromuscular problems, concentration problems, and less interest in sex were the top 5 reported complains. But at 3 months after surgery, less interest in sex was the top 1 reported complain, followed by throat/mouth problems, voice problems, psychological problems, neuromuscular problems and concentration problems. Meanwhile, the scores of most specific symptoms were decreased with the increase of postoperative time, while scores of less interest in sex were increased. Fatigue, insomnia and dyspnea were the most often reported common cancer-related symptoms for TC patients at 1 and 3 months after surgery. Interestingly, the scores of fatigue measured at 3 months after surgery were much lower than those measured at 1 month after surgery.

Throat/mouth problems, voice problems, neuromuscular problems, concentration problems, less interest in sex and fatigue are the important patient reported complains that we should pay more attention after surgery.

MiRNAs play an important role in the development of colorectal cancer (CRC); however, there is little evidence of miRNAs in the screening of the nutritional risks of patients with CRC.

This study aimed to explore the role of preoperative miR-149 in nutritional screening of patients with CRC, and its associations with clinicopathological characteristics and postoperative complications of patients with CRC.

The associations of serum miR-149 with clinicopathological characteristics and postoperative complications of patients were analyzed in this study. The receiver operating characteristic curves were plotted with miR-149 as the test variable, the grouping results of the patients with nutritional risks (total NRS2002 score ≥3 points), and no nutritional risks (total NRS2002 score <3 points) based on the preoperative NRS2002 score as the state variables. The consistency of miR-149 and NRS2002 in the nutritional screening of CRC was analyzed using the Kappa test.

MiR-149 was low in patients with CRC. There was a statistically significant difference in the miR-149 expression among patients with different tumor diameters and TNM stages in the two groups. The preoperative total NRS2002 score of CRC patients was <3 (without nutritional risks) in 271 cases, and ≥3 (with nutritional risks) in 129 cases. The sensitivity and specificity of miR-149 in the diagnosis of nutritional risks were 76.74% and 84.50%, respectively. The Kappa value was 0.622 with miR-149=3.095 as the critical value.

MiR-149 can reflect the preoperative nutritional status of patients with CRC, and miR-149=3.095 can be used as the cut-off point for nutritional risk screening of patients with CRC, which is an important index for assessing the nutritional risk in the preoperative period. The expression of miR-149 has a certain association with postoperative complications.

The Covid-19 pandemic has put unprecedented pressure on the medical staff, leading to mental disorders and burnout.

The present study aimed to compare burnout and other aspects of mental health in medical staff working in Covid-19 and non-Covid-19 wards.

This cross-sectional study was conducted in the Social Determinants of Health Research Center of Qazvin University of Medical Sciences from 10 December 2020 to 16 April 2021. A total of 384 respondents (187 cases in Covid-19 wards and 197 subjects in non-Covid-19 wards) were selected via the convenience sample method. The Maslach Burnout Inventory (MBI) and the General Health Questionnaire-28 (GHQ-28) were distributed to all participants online. Moreover, sociodemographic data and occupational conditions were collected and analyzed using appropriate statistical methods.

Basedon the results, medical staff working in Covid-19 wards had significantly higher GHQ scores, compared to those in non-Covid-19 wards (29.82±11.07 vs. 25.76±11.83; P<.001, respectively). The risk factors associated with high scores in GHQ subscales included more shifts, being a nurse and being a physician (P<0.05). In terms of burnout subscales, the medical staff working in Covid-19 wards had significantly higher depersonalization and emotional exhaustion, as well as lower individual performance (P<0.05). The risk factors associated with burnout subscales included the female gender, being a nurse, being a physician, having children, confirmed Covid-19 infection, and staff relocation during the Covid-19 pandemic (P<0.05).

As evidenced by the results of the present study, individual variables, along with the prevalence of Covid-19, can affect the psychological consequences of medical staff and be considered a risk factor for each of them.

 Silkworm cocoon produced by silkworms with the scientific name of Bombyx mori L. is a well-known medicinal agent mainly composed of proteins. This study was designed to assess the efficacy of syrup made from this natural agent on mild to moderate depression.

 The study was conducted based on a triple-blind randomized clinical trial. A total of 60 patients with mixed anxiety-depressive disorder were randomized to receive either intervention (silk syrup + sertraline) or control (placebo syrup + sertraline) for 12 weeks. Depression and anxiety were assessed using the Beck Depression and Anxiety inventories at weeks 0, 6, and 12.

 Out of the subjects, 54 patients completed the trial in two groups of intervention (n=30) and control (n=24) and entered the final analysis. According to the results of this study, the mean of anxiety and depression scores in weeks 6 and week 12 was significantly lower in the intervention group than in the control group (P<0.001).

 Silk syrup can be beneficial for the management of anxiety and depression in mild to moderate MADD; therefore, it is suggested as an adjuvant treatment to increase the efficacy of conventional medications adopted for the treatment of MADD patients.

Communication between cancer patients and healthcare providers plays a vital role in providing a better quality of life for cancer patients. However, itremains a debatable issue in society.

This study aimed to determine the quality of communication (QOC) between cancer patients and doctors and its associated factors.

This cross-sectional study was performed on a total of 600 cancer patients in the oncology clinic admitted to the oncology ward. A 19-item QOC questionnaire was administered on patients, along with measuring how patients rate the quality of this communicationabout end-of-life care to improve communication between doctors and their patients.

The cancer patients rated their doctors highly at “Including your loved ones in decisions about your illness and treatment”, “Caring about you as a person”, and “Answering all your questions”. The areas that cancer patients rated relatively low included “Most doctors do not discuss how long the cancer patients might live” and “What dying might be like”. The mean score for the overall doctor’s QOC was obtained at 8.23±0.74. This indicated that the level of doctor communicationwas close to very good communication. The following factors contributed remarkably on the scores of QOC with doctors: being 71 years old and above, holding secondary school qualifications, being diploma/degree holder, working for the government, private sector, factory, or estate, and being self-employed, being diagnosed with cancer for more than 1 year, lacking monthly income, and not staying with family.ConclusionThe results of the study showed that socio-demographic factors of cancer patients, including age, education level, employment status, working sector, illness duration, and income, could affect communication, most of the time, negatively. This issue should be taken seriously for the improvement of the care of cancer patients.

Atraumatic Splenic Rupture (ASR) is a rare but life-threatening clinicopathological phenomenon with limited information on patient features, occurrence, or etiology. ASR is an uncommon and lethal complication that is observed in infectious (mainly mononucleosis) and hematological diseases (mainly malignant homeopathies) in more than half of cases. Mortality is approximately around 20%, and some deaths occur before the diagnosis is confirmed, while others occur after surgery due to delayed management and poor patient status.

A 48-year-old man with no history of the underlying disease presented to the Emergency Department with abdominal pain. He was admitted with leukocytosis 145×103/µl, hemoglobin 6.4 g/dl, platelets 15×103/µl, erythrocyte sedimentation rate 89 mm/h, and D-Dimer 1043 ng/FEU ml. Sputum test through PCR ruled out severe acute respiratory syndrome coronavirus 2 infections. Due to peripheral blood smear and bone marrow aspiration/biopsy, acute myeloid leukemia was diagnosed for the patient. On the third day of hospitalization, the patient's abdominal pain intensifies. Ultrasound revealed medium free fluid inside the abdomen and pelvis. The patient was transferred to the operating room to undergo an emergency laparotomy. There was a large hematoma in the spleen with a rupture in its posterior surface. Splenectomy was performed, and the histopathological study of the spleen showed leukemic involvement, capsular ruptures, and subcapsular hematomas.

ASR can occur for a variety of reasons, including non-traumatic or idiopathic factors. In the absence of significant trauma, emergency physicians should be aware that splenic rupture can occur. ASR is more likely to present with symptoms similar to the underlying diseases.

The ongoing COVID-19 pandemic increased the need for inpatient beds, indicating the need for hospitals to increase the efficiency of beds.

This study aimed to increase hospital bed capacity using the implementation of Electronic Patient Discharge (EPD).

This qualitative-quantitative study was conducted in a tertiary care hospital using the pre-and post-intervention designs, and the main outcome was patient discharge time. By applying the Six Sigma model, including definition, measurement, analysis, improvement, and control, the patient discharge process was assessed and improved by some interventions such as EPD. All hospitalized patients with COVID-19 from 21 March 2020 to 22 July 2021 were examined for the post-intervention. In addition, data were collected from the hospital information system (HIS).

By the use of EPD, patient discharge time decreased to 47.70% (from 10.19 h to 5.33 h) (P < 0.000). According to the Sigma level, the yield and defects per million opportunities of the discharge process also increased to 55%.

Six Sigma methodology can be an effective change management tool to improve discharge time to cover the demand created during pandemics. According to the results of the present study and the obtained saved time, one bed is added to the hospital capacity for every five discharges.

 Professional self-concept (PSC) is an important issue concerning the nursing profession and is reflected as the key concept in nursing professionalism. Even though previous studies investigated this nursing concept and its related factors among nursing students,  meanwhile, their results showed there is no consensus.

 To assess professional self-concepts among senior nursing students and examine its relationship with gender and, Grade Point Average (GPA).

 This cross-sectional study included 157 nursing students selected by a convenience sampling among senior nursing students in the seventh semester in January  2020, at Mashhad University of Medical Sciences (MUMS), Iran. The data were collected using Cowin’s 36-item questionnaire of  NPSC which measures nursing self-concept in six dimensions.

 The age of undergraduate nursing students vary from 22 to 24 years old (22.58 ± 98). Two-thirds of the students were female (66%) and married (71%). The nursing students reported a total mean score of PSC was (161.1 ± 3.27). The highest mean score of the PSC dimensions belonged to communication (27.7 ± 1.17) and the lowest mean score was observed for self-esteem (25.52 ± 1.06).There was no significant difference between gender and total professional self-concept and its dimensions and also no relationship with GPA  except for the staff relations subscale, (r= -.198, p<0.05) and leadership subscale (r= -.210, p<0.05) which was a negative and significantly correlated but the correlation coefficients were weak (<0.3).

 Given a moderate level of total professional self-concept and the lowest dimensions in self-esteem among nursing students, it is recommended that nursing students’s professional self-concept and its dimensions specifically in self-esteem, which can boost their nursing professionalism, be given more consideration.