Effect of the Specific Training Course for Competency in Doing Arterial Blood Gas Sampling in the Intensive Care Unit: Developing a Standardized Learning Curve according to the Procedure's Time and Socioprofessional Predictors

BACKGROUND

Standardization of clinical practices is an essential part of continuing education of newly registered nurses in the intensive care unit (ICU). The development of educational standards based on evidence can help improve the quality of educational programs and ultimately clinical skills and practices.

OBJECTIVES

The objectives of the study were to develop a standardized learning curve of arterial blood gas (ABG) sampling competency, to design a checklist for the assessment of competency, to assess the relative importance of predictors and learning patterns of competency, and to determine how many times it is essential to reach a specific level of ABG sampling competency according to the learning curve.

DESIGN

A quasi-experimental, nonrandomized, single-group trial with time series design. Participants. All newly registered nurses in the ICU of a teaching hospital of Tehran University of Medical Sciences were selected from July 2016 to April 2018. Altogether, 65 nurses participated in the study; however, at the end, only nine nurses had dropped out due to shift displacement.

METHODS

At first, the primary checklist was prepared to assess the nurses' ABG sampling practices and it was finalized after three sessions of the expert panel. The checklist had three domains, including presampling, during sampling, and postsampling of ABG competency. Then, 56 nurses practiced ABG sampling step by step under the supervision of three observers who controlled the processes and they filled the checklists. The endpoint was considered reaching a 95 score on the learning curve. The Poisson regression model was used in order to verify the effective factors of ABG sampling competency. The importance of variables in the prediction of practice scores had been calculated in a linear regression of R software by using the relaimpo package.

RESULTS

According to the results, in order to reach a skill level of 55, 65, 75, 85, and 95, nurses, respectively, would need average ABG practice times of 6, 6, 7, 7, and 7. In the linear regression model, demographic variables predict 47.65 percent of changes related to scores in practices but the extent of prediction of these variables totally decreased till 7 practice times, and in each practice, nurses who had the higher primary skill levels gained 1 to 2 skill scores more than those with low primary skills.

CONCLUSIONS

Utilization of the learning curve could be helpful in the standardization of clinical practices in nursing training and optimization of the frequency of skills training, thus improving the training quality in this field. This trial is registered with NCT02830971.

The -4817 G>A (rs2238136) variant of the vitamin D receptor gene: a probable risk factor for colorectal cancer

Vitamin D appears to have anti-tumor activities in the large bowel. Our aim was to investigate whether -4817 G>A (rs2238136) polymorphism located at 5'-untranslated region (5'-UTR) of the human vitamin D receptor (VDR) gene was associated with colorectal cancer (CRC) risk. We conducted a case-control study and VDR genotypes, determined by Bpu10I restriction endonuclease digestion of PCR-amplified DNA, were performed on 327 cases with CRC and 327 controls. The distribution of VDR -4817 G>A genotypes and alleles differed significantly between cases with CRC and controls even after adjustment for confounding factors such as age, BMI, sex, and smoking status. Individuals carrying the "AA" genotype had a 2.09-fold increased risk compared with those with "GG" genotype (P = 0.016, OR = 2.09, 95% CI = 1.15-3.78) and a 1.87-fold increased risk compared with those with "GG and GA" genotypes (P = 0.033, OR = 1.87, 95% CI = 1.05-3.33) for CRC. Furthermore, the VDR "A" allele was significantly overrepresented in cases with CRC than controls (P = 0.044; OR = 1.28, 95% CI = 1.01-1.63). Interestingly, the analysis of the SNP revealed that all these associations were stronger for women subjects than for all subjects combined. These data indicated for the first time a direct association between "AA" genotype of VDR gene -4817 G>A polymorphism and CRC, with a stronger association for female subjects. However, our findings remain to be confirmed in other populations.

Assessment of 5-year outcomes of life satisfaction in survivors after rehabilitation programs: a multicenter clinical trial

Using a rehabilitation program for the survivors of acute respiratory distress syndrome (ARDS) could be one of the important and fundamental steps to improve the pulmonary function and health-related quality of life (HRQoL) of patients. This study was carried out to evaluate the effect of two rehabilitation techniques (Family-Based Empowerment Model (FECM)/Continuing Care Model (CCM), or both of them) on pulmonary function, and HRQoL in ARDS survivors. From December 2009 to June 2016, ARDS survivors from mixed medical-surgical ICUs at four academic teaching hospitals in Tehran, Iran, were randomly assigned to one of three intervention groups (A, B, or C) or a control group (D). Pre- and post-interventions, pulmonary functions and HRQoL status of patients in all groups were collected 48 times via clinical measurements and various questionnaires during 5 years of follow-up. Significantly improvement was seen in the intervention groups compared to the control group, and the greatest benefit was observed in patients who received mixed of FCEM and CCM rehabilitation techniques. Co-administration of FCEM and CCM can improve pulmonary function as well as the life satisfaction of ARDS survivors. As a result, the execution of the empowerment model by nurses is recommended for ARDS survivors and the participation of their families at the same time.Trial registration: NCT02787720 (ClinicalTrial.gov, 24/05/2016).

Increased oesophageal cancer mortality rate in Iran

BACKGROUND AND STUDY AIMS

The aim of this study is to present the mortality trends of oesophageal cancer (EC) in the Iranian population, to provide updated information regarding time trends for this cancer.

PATIENTS AND METHODS

We analysed the national death statistics reported by the Iranian Ministry of Health and Medical Education from 1995 to 2004. EC [International Classification of Diseases (ICD-9); C15] were expressed as the annual mortality rates/100000, overall, by sex and by age group (<15, 15-49 and ≥ 50 years of age) and age standardised rate (ASR).

RESULTS

The age standardised mortality rate of EC increased dramatically during the study period. EC mortality was higher for males and the mortality rate also increased with age.

CONCLUSION

This study provides a comprehensive projection for the burden of death due to EC, indicating that the trend of EC mortality dramatically increased in the recent decade.

Footprint as an alternative to X-ray in hallux valgus angle measurement

Background: X- ray images provide accurate and reliable data in different foot pathologies. However, the accompanied complications will limit its use for epidemiological studies and research purposes, especially in children. Therefore, simple, accessible, and cost- effective methods such as footprint, with a good correlation with x-ray images, are needed to help diagnose different foot pathologies. In the present study, the accuracy of footprint technique in assessing hallux valgus angle (HVA) was evaluated based on x-ray images through measuring the angle between the medial border protrusion of the foot and the hallux. Methods: In this cross-sectional study, 42 participants with symptomatic hallux valgus were recruited. HVA was measured by both x-ray imaging and footprint. The differences between the two approaches were identified by applying correlation-coefficient test and reliability, which was assessed using interclass correlation (ICC). Results: A significant correlation was found between the HVA measured by x-ray and HVA by footprints (p< 0.001), and the ICC was upper than 90%. Conclusion: Foot print is a reliable method for measuring HVA, as it was highly correlated with the HVAs obtained by x-ray imaging.

The effects of IL-8, IL- 6, and IL-1 on the risk of celiac disease: a Bayesian regression analysis

AIM

The present study aimed to evaluate the association between serum levels of interleukin IL-1, IL-6, IL-8 genes as well as interferon (IFN)-γ and the risk of celiac disease (CD).

BACKGROUND

The role of serum cytokine levels in the pathophysiology of CD is still an open field to be explored.

METHODS

This case-control study was performed on 110 patients with CD and 46 healthy controls referring to Taleghani Hospital, Tehran, Iran. Expression levels of IL-1, IL-6, IL-8, and IFN-γ were assessed by enzyme-linked immunosorbent assay (ELISA) kits.

RESULTS

The Bayesian intervention odds ratio (OR) and Highest Posterior Density (HPD) interval were 1.133 (95% credible interval 1.018- 1.269), 0.947 (95% credible interval 0.898 - 0.996) and 1.004 (95% credible interval 1.001- 1.009) for IL-1, IL-6, and IL-8 respectively.

CONCLUSION

The serum level of IFN-γ has no effect on the risk of CD, but given the OR and the HPD interval obtained for serum levels of IL-1, IL-6 and IL-8, with one unit increase in IL-1 serum, the risk of CD grows by 1.13 times while one unit increase in IL-6 serum reduces the risk of CD by 15%. Finally, regarding IL-8, the risk of CD increases by 0.004 times with a unit increase in IL-8 serum.

Palliative care nurse: A quantitative study of caring for neonates at end-of-life stage

OBJECTIVE

This study aimed to evaluate the quality of the care provided to newborns at End-of-Life (EOL) stages and compare the care which is already being given to the infants admitted to the NICUs of the selected hospital in (XXX) with the existing standards. Knowing how End-of-Life nursing care is provided, compared with the standard in the terminal stage of neonates' life can provide accurate information for policies, research, and educational practices.

METHODS

In this descriptive study, 100 nursing care services, provided to neonates at the EOL stages and their parents, were observed and compared to the standard checklist which had been developed based on the literature review and existing standards in 2015. The study setting included the NICUs of the four hospitals affiliated to (XXX) The Content and Face Validity of the checklist were determined based on specialists' comments. The Content Validity Index was 94.85%, and its reliability was evaluated too through the inter-rater correlation coefficient (ICC = 0.715).

RESULTS

Only 11.49% of EOL nursing care services were given properly and 77.92% were not given at all. Results showed that 10.59% of EOL nursing care services were performed improperly.

CONCLUSION

The overall rate of accordance with the EOL nursing care standards was poor (16.78%). Nursing care given to infants and their parents at EOL stages is far from the standards. This can be due to various reasons, such as inadequate training and the lack of comprehensive guidelines.

Prevalence of celiac disease in patients with atypical presentations

BACKGROUND AND STUDY AIMS

Unawareness about atypical forms of celiac disease (CD) leads to the underdiagnoses of CD. This study has investigated the prevalence of CD in patients with atypical presentations, such as idiopathic low bone mineral density (ILBMD) and dyspepsia, in the Iranian population.

PATIENTS AND METHODS

Two separate groups of patients who have been diagnosed with dyspepsia and ILBMD (including either osteopenia or osteoporosis of unknown cause) were screened for CD during 2016-2019. Patients were serologically screened by means of IgA anti-tissue transglutaminase (IgA anti-tTG); in case of positive results, the patients underwent endoscopic intestinal biopsy to confirm the diagnosis of CD.

RESULTS

Of 200 patients with ILBMD, six (3%) had a positive result for IgA anti-tTG; in five cases (2.5%), duodenal histology confirmed the CD diagnosis. Of 290 patients with dyspepsia, 25 (8.6%) had a positive result for anti-tTG IgA; nine cases (3.7%) were histologically compatible with CD. No significant differences were found between the two groups of patients.

CONCLUSIONS

The prevalence of CD in patients with atypical presentations, such as ILBMD and dyspepsia, is consistent (pvalue = 0.788) and higher than that in the general population (p value = 0.001); therefore, screening program for CD in these patients is highly recommended.

Evaluation of the left-to-right shift of colon tumors in Iran: Is the trend changing?

BACKGROUND

Colorectal cancer (CRC) is the second cause of cancer-related deaths worldwide. There have been several studies reporting the proximal tumor shift, especially in Western countries. In the present study, we investigated the clinicopathologic and anatomical distributions of colorectal tumors in Iranian CRC patients.

MATERIALS AND METHODS

In this retrospective cohort study, 258 patients with CRC from 2008 to 2013 were evaluated. Comparison of variables was performed using Pearson's chi-square test and Fisher's exact test depending on the nature of the data.

RESULTS

A total of 258 patients including 124 (48.1%) females and 134 (51.9%) males enrolled in this study. The majority of cancers were detected in the rectosigmoid, i.e., 98 (38%) followed by the left colon, i.e., 84 (32.6%) and the right colon, i.e., 76 (29.5%). In the present study, we observed the significant association between metastases, adjuvant therapy, family history, and history of inflammatory bowel disease (IBD) with tumor, node, and metastasis (TNM) staging (P < 0.001). In univariate analysis, there was a strong association between overall survival (OS) and stage II CRC (P = 0.03). However, the predictive value was lost in multivariate analysis (P = 0.145).

CONCLUSION

Unlike the majority of previous studies on Iranian CRC patients, we observed a considerably higher occurrence of right-sided colon cancers (84 versus 76). Although this phenomenon did not reach the statistical significance rate, based on recent studies on Iranian population including the present one, the pattern of anatomical distribution of colorectal tumors has been changed toward the proximal colon. This requires an urgent need to provide other strategies and complementary detecting approaches in order to identify proximal tumors in Iranian CRC patients.

Association of LXRα polymorphisms with obesity and obesity-related phenotypes in an Iranian population

BACKGROUND

Obesity is a multifactorial disorder due to the complex interaction between genetic and environmental factors. Liver X receptor alpha (LXRα), encoded by the gene NR1H3, is involved in lipoprotein metabolism and its genetic variations may also play a role in the aetiology of obesity.

AIM

To assess the association of two NR1H3 polymorphisms (rs11039155 and rs2279238) and their haplotypes with obesity in an Iranian population.

SUBJECTS AND METHODS

A total of 447 unrelated subjects (including 206 overweight, 162 obese and 79 controls) were enrolled in the study and were genotyped by TaqMan assay using DNA from peripheral blood. The association of these two LXRα polymorphisms with the presence of obesity and overweight was assessed.

RESULTS

There was no significant association between the two SNPs and obesity, even after adjustment for age and sex. By logistic regression using a dominant model, the odds ratios for obesity were: 1.32 (0.85-2.74) for rs11039155 and 0.77 (0.30--1.99) for rs2279238. Haplotype analyses identified three common haplotypes GC, GT and AC with frequency greater than 1%, but none of the haplotypes was associated with the risk of obesity.

CONCLUSIONS

This study revealed that there was no significant association between LXRα polymorphisms and the presence of obesity in an Iranian population and suggests that these two SNPs are not major contributors to obesity risk in this population.

Bayesian adjustment of gastric cancer mortality rate in the presence of misclassification

AIM

To correct for misclassification error in registering causes of death in Iran death registry using Bayesian method.

METHODS

National death statistic from 2006 to 2010 for gastric cancer which reported annually by the Ministry of Health and Medical Education included in this study. To correct the rate of gastric cancer mortality with reassigning the deaths due to gastric cancer that registered as cancer without detail, a Bayesian method was implemented with Poisson count regression and beta prior for misclassified parameter, assuming 20% misclassification in registering causes of death in Iran.

RESULTS

Registered mortality due to gastric cancer from 2006 to 2010 was considered in this study. According to the Bayesian re-estimate, about 3%-7% of deaths due to gastric cancer have registered as cancer without mentioning details. It makes an undercount of gastric cancer mortality in Iranian population. The number and age standardized rate of gastric cancer death is estimated to be 5805 (10.17 per 100000 populations), 5862 (10.51 per 100000 populations), 5731 (10.23 per 100000 populations), 5946 (10.44 per 100000 populations), and 6002 (10.35 per 100000 populations), respectively for years 2006 to 2010.

CONCLUSION

There is an undercount in gastric cancer mortality in Iranian registered data that researchers and authorities should notice that in sequential estimations and policy making.

Cause-specific hazard regression estimation for modified Weibull distribution under a class of non-informative priors

In time to event analysis, the situation of competing risks arises when the individual (or subject) may experience p mutually exclusive causes of death (failure), where cause-specific hazard function is of great importance in this framework. For instance, in malignancy-related death, colorectal cancer is one of the leading causes of the death in the world and death due to other causes considered as competing causes. We include prognostic variables in the model through parametric Cox proportional hazards model. Mostly, in literature exponential, Weibull, etc. distributions have been used for parametric modelling of cause-specific hazard function but they are incapable to accommodate non-monotone failure rate. Therefore, in this article, we consider a modified Weibull distribution which is capable to model survival data with non-monotonic behaviour of hazard rate. For estimating the cumulative cause-specific hazard function, we utilized maximum likelihood and Bayesian methods. A class of non-informative types of prior (uniform, Jeffrey's and half-t) is introduced for Bayes estimation under squared error (symmetric) as well as LINEX (asymmetric) loss functions. A simulation study is performed for a comprehensive comparison of Bayes and maximum likelihood estimators of cumulative cause-specific hazard function. Real data on colorectal cancer is used to demonstrate the proposed model.

Development of web-based dynamic nomogram to predict survival in patients with gastric cancer: a population-based study

Gastric cancer (GC) is the fifth most frequent malignancy worldwide and the third leading cause of cancer-associated mortality. The study's goal was to construct a predictive model and nomograms to predict the survival of GC patients. This historical cohort study assessed 733 patients who underwent treatments for GC. The univariate and multivariable Cox proportional hazard (CPH) survival analyses were applied to identify the factors related to overall survival (OS). A dynamic nomogram was developed as a graphical representation of the CPH regression model. The internal validation of the nomogram was evaluated by Harrell's concordance index (C-index) and time-dependent AUC. The results of the multivariable Cox model revealed that the age of patients, body mass index (BMI), grade of tumor, and depth of tumor elevate the mortality hazard of gastric cancer patients (P < 0.05). The built nomogram had a discriminatory performance, with a C-index of 0.64 (CI 0.61, 0.67). We constructed and validated an original predictive nomogram for OS in patients with GC. Furthermore, nomograms may help predict the individual risk of OS in patients treated for GC.

Is there any association between plasma lipid profile and severity of COVID-19?

BACKGROUND

COVID-19 is an infectious disease which caused a pandemic with many diseases and fatalities. This new variant of coronavirus called SARS-CoV-2 and is primarily characterized by respiratory symptoms. There are some data indicating that LDL-cholesterol (LDL-C) as well as HDL-cholesterol (HDL-C) levels are inversely correlated to disease severity and could act as a predictor for disease progression and unfavorable prognosis. However, the results of some other studies do not confirm this. This current study aimed to provide an answer to this question.

METHODS

This prospective, single-center study analyzed 367 confirmed COVID-19 patients to find whether there are any differences in plasma lipoproteins between survivors and non-survivors patients or between the patients with a "duration of ≤10 days intensive unit care (ICU) stay" and patients with a "duration of >10 days ICU stay".

RESULTS

No association between any lipid/lipoprotein parameter and the severity of COVID-19 could be found but survivors and non-survivors did differ concerning total cholesterol and LDL-C levels.

CONCLUSION

Multivariate cox regression analysis could not prove any association between lipids/lipoproteins and severe events in COVID-19 patients. Significantly less non-survivors with COVID-19 were taking atorvastatin than survivors which is consistent with the majority of previous findings.

Non-erosive reflux disease compared with erosive esophagitis with regards to acid reflux and symptom patterns

BACKGROUND/AIMS

Non-erosive reflux disease and erosive esophagitis are the most common phenotypic presentations of gastroesophageal reflux disease. Recent reports suggest that patients with non-erosive reflux disease treated with antireflux medications show lower symptom improvement rates than patients with erosive esophagitis treated with the same medications. The aim was to assess the acid reflux and symptom patterns of patients with non-erosive reflux disease in comparison with those with erosive esophagitis and to identify different non-erosive reflux disease subgroups.

MATERIAL AND METHODS

One hundred and twenty consecutive patients (67 male, age: 37.6±12.9 years) seen for classic heartburn symptoms were evaluated for the study. The patients underwent upper endoscopy and 24-hour ambulatory pH monitoring.

RESULTS

Erosive esophagitis was identified in 51 patients and nonerosive reflux disease in 69 patients. According to pH metric findings (DeMeester Score >14.72 or Fraction Time >4%), 31.9% of the non-erosive reflux disease group and 47.1% of the erosive gastroesophageal reflux disease group had abnormal acid reflux (p=0.134). Erosive esophagitis patients showed a similar pattern of acid reflux to non-erosive reflux disease patients in the different positions (supine and upright). Non-erosive reflux disease-negative (normal pH test) patients demonstrated a significantly lower degree of esophageal acid exposure when compared with those with erosive esophagitis. About 10.6% of the non-erosive reflux disease-negative patients and 45.5% of the non-erosive reflux disease-positive (abnormal pH test) patients had a positive symptom index (≥50%) during the distal pH metry (p=0.003).

CONCLUSIONS

Acid reflux characteristics and symptom patterns suggest that the non-erosive reflux disease group represents a heterogeneous group of patients.

Relation between demographic factors and hospitalization in patients with gastrointestinal disorders, using quantile regression analysis

OBJECTIVE

The aim of this study is to investigate relation between demographic factors and hospitalization in gastrointestinal disorders. Quantile regression was used to analyze the predictors of duration of staying in hospital for patients with GI disease.

METHODS

This study was designed as a retrospective cross-sectional survey included all consecutive gastrointestinal (GI) patients admitted over one year period in a random selected hospital group located in Tehran metropolitan in 2006. Residence, age, sex and type of GI disorders were analyzed respectively using quantile regression.

RESULTS

A total of 6405 patients with GI disorders were included in the study, There were 3633 men (56.7%) and 2772 women (43.3%). Type of diseases was a significance predictor for length of staying at hospital in quantile regression analysis. Age was significant only in second quartile and sex was not assessed as a predictor at all.

CONCLUSION

The results have demonstrated that duration of hospitalization for inpatients with GI cancers was longer than other groups and quantile analysis drawn a good picture of predictors for length of hospitalization.

Effect of family-centered empowerment model on self-efficacy in patients with obsessive compulsive disorder: A quasi-experimental study

Objective: Obsessive compulsive disorder is one of the most common disorders affectig the individuals’ performance. Promotion of self-efficacy is important in these patients. This study determined the impact of family-centered empowerment model on self-efficacy in patients with obsessive compulsive disorder. Material and Methods: This was a quasi-experimental single group before-after intervention study, which conducted on 36 patients with Obsessive compulsive disorder. The samples were selected with purposive sampling method using inclusion criteria. The family-centered empowerment model was implemented in 5 sessions for 3 months focusing on four categories (perceived threat, self-efficacy, educational contribution, and assessment). The instrument used consisted of two parts including demographic information questionnaire and Self-efficacy Questionnaire which was completed before, immediately after, and 1.5 month after intervention by the study units. The data were analyzed with SPSS21 using descriptive Statistics, repeated measure ANOVA and paired t-test. Results: The mean selfefficacy scores were 47.78±8.71 and 51.44±10.83 before and after intervention, respectively (P=0.04). Also, a comparison of self-efficacy scores with t-test before and after intervention and follow-up indicated a significant correlation (P<0.05). Conclusion: Our findings showed the implementation of family-centered empowerment model could be recommended to increase the rate of self-efficacy in patients with obsessive compulsive disorder. Bangladesh Journal of Medical Science Vol.20(2) 2021 p.274-280