The biotoxic effects of heavy metals exposure in miners and non-miners

Since little is known about the comparison of the biotoxic effects of heavy metals exposure on biochemical and hematological parameters in miners and non-miners, the current study aimed to compare the effects of arsenic (As), lead (Pb), and copper (Cu) in both groups. Demographic information and blood samples were collected from all participants and measures of As, Pb and Cu were obtained using Atomic Absorption Spectrophotometry. As and Pb mean concentrations in miners and Cu concentration were greater in non-miners. Miners also showed significantly higher level of RBC, HBG and HCT. In the adjusted model, cholesterol showed a positively association with Pb and Cu levels. Triglycerides, GGT, ALP, WBC and PLT positively and HDL-cholesterol negatively were associated with Cu. Creatinine was negatively associated with group variable. In conclusion, miners' high blood heavy metals concentrations can impact biochemical and hematological indices. These observations make monitoring of heavy metals necessary in miners.

The Effect of Mindfulness on Posttraumatic Growth of Mothers of Premature Infants Admitted to Neonatal Intensive Care Unit

The purpose of this study was to determine the effect of Mindfulness-Based Stress Reduction (MBSR) on Posttraumatic Growth (PTG) in mothers of premature infants admitted to the Neonatal Intensive Care Unit (NICU) in Iran. Sixty mothers were selected by convenience sampling and assigned to the intervention and control groups. The intervention group received two MBSR sessions each week over the course of three weeks. The Posttraumatic Growth Inventory (PTGI) was used to collect data before, immediately after, and 1 month after the intervention. Based on repeated measures ANOVA, group-by-time interaction effect was significant and there was a statistically significant difference in the mean PTG scores of mothers in the two groups over time (p = 0.004). MBSR increased PTG in mothers. As a result, it is suggested that this approach be used in psychological support programs for mothers who have premature infants admitted to neonatal intensive care units.

The profile of Oral Health Branch of Rafsanjan Cohort Study (OHBRCS) in Rafsanjan City, southeast of Iran

Oral health status can be affected by some factors including drug abuse, systemic conditions and environmental pollutants. The present study was designed to investigate the most important and prevalent dental and oral conditions in adult population of Rafsanjan with the age of 35-70 years. Dental and oral health cohort center as part of the Rafsanjan Cohort Study (RCS) included in the prospective epidemiological research studies in IrAN was established in 2015. Of 9991 subjects enrolled in the RCS, 8682 people participated in the Oral Health Branch of Rafsanjan Cohort Study (OHBRCS). The OHBRCS included 4021 men and 4661 women with the mean age of 49.94 ± 9.51. The most prevalent of oral lesion in total population was candidiasis and the least was aphthous lesion. The prevalence of candidiasis, white and red lesions, periodontal pocket, dental calculus, CAL and the mean of DMFT were higher in the male group than that of female group (p < 0.05). Candidiasis, herpes, oral cancer, white and red lesions were more prevalent in the older age groups (p < 0.05). The mean of DMFT index in total population was 21.30 and was higher among opium users, men and older age (p < 0.05). Also, the opium users had a higher rate of CAL, periodontal pocket, red and white lesions, and candidiasis but a lower rate of BOP (p < 0.05). Younger people had more decayed and filling teeth compared to other age groups, whereas older people had more missing teeth and a higher DMFT index (p < 0.001).

Comparing the association between heavy metals and cognitive status and depression in miners and non-miners: A study from southeast of Iran

Heavy metal toxicity is a major public health crisis worldwide, especially in mining environments. The association between chronic heavy metals exposure and cognitive impairment has not been studied broadly in adults and mining fields. This study aimed to compare the association between arsenic (As), lead (Pb), and copper (Cu) concentration in blood and cognitive status and depression in copper miners and non-miners. Participants were selected from the Rafsanjan cohort study (RCS) as non-miners and miners from Sarcheshmeh Copper Complex. For evaluation of cognitive performance and creativity, comprehensive neurological tests were performed as follows: Mini-Mental Status Examination (MMSE), Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Psychomotor Vigilance Task (PVT), creativity tests including remote association task (RAT) and alternative uses task (AUT). Beck Depression Inventory-II was used to evaluate depression. Standard laboratory tests were also performed. Atomic absorption spectrophotometry was used to estimate the blood's concentration of As, Pb and Cu. We observed a significant difference between arsenic, lead, copper, and depression scores (all P < 0.001) in the two groups (miners and non-miners). Miners had a better performance in cognitive fields except in MMSE and PVT tests. Linear regression analyses showed that the lead had a negative association with the PVT test and depression score. The results suggest that the development of depression, cognitive impairments, and other health problems is possible in chronic heavy metal exposure, especially lead (Pb). Confirmation of our claim requires further study in the coming years.

Association between metabolic syndrome and stroke: a population based cohort study

Both metabolic syndrome (MetS) and stroke are associated with increased risk of mortality. Here, we aimed to assess the prevalence of MetS among adults using three definitions (Adult Treatment Panel III (ATP-III), International Diabetes Federation (IDF) and IDF ethnic specific cut-off for Iranian criteria) and its association with stroke. We performed a cross-sectional study of a total of 9991 adult participants of Rafsanjan Cohort Study (RCS), as part of the Prospective epidemiological research studies in Iran (PERSIAN cohort study). The MetS prevalence was evaluated in participants according to the different criteria. Multivariate logistic regression analyses were conducted to assess the association between three definitions of MetS with stroke. We found that MetS was significantly associated with higher odds of stroke according to NCEP-ATP III (odds ratio (OR): 1.89, 95% confidence interval (CI) 1.30-2.74), international IDF (OR:1.66, 95% CI: 1.15-2.40) and Iranian IDF (OR:1.48, 95% CI: 1.04-2.09) after adjusted for variables confounders. Furthermore, after adjustment, in receiver operating characteristic (ROC) curve, the AUROC was 0.79 (95% CI = 0.75-0.82), 0.78(95% CI = 0.74-0.82) and 0.78(95% CI = 0.74-0.81) for presence of MetS according to NCEP-ATP III, international IDF and Iranian IDF, respectively. ROC analyses revealed that all of these three criteria for MetS are "moderately accurate" for the identification of increased stroke risk.In conclusion, our results showed that MetS was associated with increased odds of stroke. Our findings implicate the importance of early identification, treatment, and ultimately prevention of the metabolic syndrome.

The prevalence and associated factors of overweight/obesity and abdominal obesity in South-eastern of Iran: a cross-sectional study based on Rafsanjan cohort study

BACKGROUND

Obesity has become a major health issue in both high and middle-income countries, increasing the risk of cardiovascular diseases and all-cause mortality. Risk of obesity is related to both unchangeable factors such as genetics and gender, and modifiable lifestyle factors. Most importantly, finding the major modifiable lifestyle factors which contribute to obesity may provide valuable benefits to every society. This study aimed to determine the association of demographic and lifestyle parameters with overweight/obesity and abdominal obesity in a population of Iranian adults.

METHODS

In this cross-sectional study, adult participants of Rafsanjan Cohort Study (RCS) (as one of the district areas of the PERSIAN cohort (Prospective Epidemiological Research Studies in IrAN) included the study population. RCS is a population-based prospective cohort of men and women aged 35-70 years, launched in August 2015. Individuals were recruited from four urban and suburban areas of Rafsanjan, south-eastern of Iran. Trained experts interviewed each participant and completed the related questionnaires about his/her socioeconomic status, demography, anthropometric features, personal habits, physical activity and medical history. Multinomial logistic regression models were used to examine the relationships between overweight/obesity/abdominal obesity and associated factors.

RESULTS

From 9980 participants, 1974 (42.42%) males and 2115 (39.70%) females were overweight, 784 (16.85%) males, 2223 (41.73%) females were obese and 1895 (40.73%) males and 989 (18.57%) females were normal weight. Also, 832 (17.9%) males and 4548 (85.4%) females had abdominal obesity and 3819 (82.1%) males and 778 (14.6%) females didn't have abdominal obesity. Based on the adjusted multiple logistic regression, overweight/obesity (BMI > 25) was associated with age > 45, female gender, education ≥ 13 years, heavy physical activity, wealth status index (WSI), alcohol consumption, current cigarette smoking and opium consumption compared to reference group. Also, odds of abdominal obesity displayed a significant association with age > 45, female gender, education > 5 years, physical activity, WSI, current cigarette smoking, alcohol and opium consumption compared to reference group.

CONCLUSIONS

Our results recommend local public health strategies that promote training the society on the health benefits of avoiding alcohol, getting more physical exercise and gaining more personal education on the health-threatening lifestyle.

Comparison the effect of valerian and gabapentin on RLS and sleep quality in hemodialysis patients: A randomized clinical trial

INTRODUCTION

This study aimed to compare the effect of valerian and gabapentin on restless legs syndrome (RLS) and sleep quality in HD patients.

METHODS

In this cross over clinical trial study, 40 HD patients allocated into a valerian and gabapentin group. In the first phase of the study, Group A received valerian and Group B received gabapentin 1 h before bedtime for 1 month. In the second phase, the two groups' treatment regimen was swapped. After a 1-month washout period, the same process was repeated on the crossover groups.

RESULTS

After the first phase, the mean score of RLS was lower in the gabapentin group. But there was no statistically significant difference between the two groups in terms of sleep quality score before and after the first and second interventions.

CONCLUSION

Gabapentin is more effective than valerian in improving RLS, but both are equally effective in improving sleep quality.

Cohort-based analysis of maternal age at menarche in relation to young adult offspring anthropometric and metabolic parameters

OBJECTIVES

Age of menarche is a determinant factor of cardiometabolic risk, adiposity and stature at adulthood. However, little is known about the transgenerational effects of age of menarche, especially beyond childhood of any offspring, and the studies remain limited to anthropometric outcomes in children at birth or before adolescence. In the present study, we aim to investigate the relationship of maternal age at menarche (MAM) with anthropometric and metabolic parameters in the young adult offspring (aged 15-35 years) in a Persian population.

DESIGN, PATIENTS AND MEASUREMENTS

In this cohort-based cross-sectional study, we recruited 1139 mother-young adult dyads enroled in Rafsanjan Cohort Study (RCS) at adult RCS (aged 35-70 years) and youth RCS (aged 15-35 years) as part of the comprehensive PERSIAN (Prospective Epidemiological Research Studies in IrAN). In this study, MAM was categorized to early (MAM < 12 years), normal (12 ≤ MAM ≤ 14) and late menarche (MAM > 14 years). For these analyses, bivariate and multiple logistic regression models were used to investigate the relationships between late or early MAM and offspring anthropometric and metabolic parameters.

RESULTS

Early MAM displayed a significant association with an increased odds ratio (OR) of tall stature adjusting for sex, age, socioeconomic status index, maternal age at birth and maternal height (as genetically determined factor). Sensitivity analysis by sex indicated this relationship to be specific to male offspring only (adjusted OR: 1.84 95% CI: 1.13-3.00, p value: .014). In addition, late MAM displayed a significant association with reduced OR of overweight/obesity and abdominal obesity in daughters only (obesity adjusted OR: 0.49, 95% CI: 0.27-0.88, p value: .018, abdominal obesity adjusted OR: 0.44, 95% CI: 0.23-0.82, p value: .010). dose-response analysis by categorization of MAM, further supported our results. On the contrary, our analyses do not support a significant relationship between MAM and youth metabolic indices, that is, metabolic syndrome, fasting blood sugar (FBS), high-density lipoprotein (HDL) and triglyceride (TG).

CONCLUSIONS

The results of the present study indicate an association of maternal age of menarche with anthropometric measures of offspring in young adulthood in a sex differential manner. The data does not support a significant relationship between the metabolic indices FBS, TG and HDL in offspring with MAM. Overall, this study provides evidence for the intergenerational effects of age at menarche in the development of anthropometric measures in offspring in young adulthood (15-35), which is the first study of this kind in this age range.

Risk factors of kidney stone disease: a cross-sectional study in the southeast of Iran

BACKGROUND

The prevalence of kidney stones in the world is increasing and environmental factors seem to play a major role in this issue. The aim of the present study was to investigate the prevalence of risk factors of kidney stones in the adult population of Rafsanjan city based on the data of the Rafsanjan Cohort Study (RCS).

METHODS

In the baseline phase of this study, 10,000 people aged 35 to 70 years are enrolled in the RCS, as one of the prospective epidemiological research studies in Iran. From this population, 9932 participants completed related demographic questionnaires as well as reported a history of diabetes mellitus, kidney stone, and hypertension diseases. The obtained data were analyzed using univariable and multivariable logistics regression.

RESULTS

According to the obtained results, 46.54% of the studied population were male and 53.46% were female. The mean age of the participants was 49.94 ± 9.56 years. 2392 people accounting for 24.08% of the population had kidney stones. After adjustment of the variables, six variables of gender, WSI, no consumption of purified water, BMI, and history of hypertension and diabetes were found to be significant related factors of kidney stone disease.

CONCLUSIONS

Gender, hypertension, obesity, diabetes, and personal habits like alcohol consumption, opium use and, cigarette smoking are effective in the development of kidney stones. So, by identifying the susceptible patients and teaching them, the burden of the disease on society and the individual can be reduced. The results of this study are helpful to health care providers for preventive planning for kidney stone disease.

The effect of rosemary ointment on the pressure ulcer healing in patients admitted to the intensive care unit: A randomized clinical trial

Background & Aim: Pressure ulcers have been identified as one of the most important and challenging issues in patient’s well-being. Based on the evidence, rosemary extract compounds can affect wound healing. The aim of this study was to determine the effect of rosemary ointment on pressure ulcer healing in patients admitted to the intensive care unit. Methods & Materials: In this single-blind randomized parallel clinical trial, 70 patients who met the inclusion criteria were selected purposefully and assigned to the groups by stratified randomization method. In the intervention group, rosemary ointment was applied once a day for seven days. The control group received routine care. Data were collected using the Pressure Ulcer Scale for Healing before the intervention and on the third and seventh days after the intervention. Data were analyzed using independent t-test, chi-square test, and two-way repeated measurements ANOVA with SPSS 18 software. Results: The mean scores of Pressure Ulcer Scale for Healing decreased significantly in the intervention group while remained unchanged in the control group (P=0.001) one week after the intervention. The effect of time and interaction effect was also significant (P=0.001). Comparison of the ratio of complete ulcer healing in the two groups showed a significant difference between the two groups (p=0.004). Conclusion: Rosemary ointment facilitated healing and prevented the progression of grade І pressure ulcers in the Intensive Care Unit. Therefore, the use of this ointment as a low-risk, uncomplicated, available, and inexpensive intervention, is recommended in such patients.

The Effect of Supportive-Training Intervention on the Burnout ofMothers with Disabled Child: A Randomized Clinical Trial

Introduction: Mothers with a disabled child experience excessive stress, fatigue, frustration, and depression. Failure of mothers to effectively deal with these symptoms can lead to chronic fatigue and, in the long run, burnout. The objective of the present study was to determine the effect of supportive-training intervention on the burnout of mothers with disabled children. Methods: In this randomized controlled trial, 70 mothers with disabled children studying in special schools were selected in one of the urban areas of Iran. They were divided into two groups of intervention and control, using Minimization Random Method. In the intervention group, mothers participated in supportive-training sessions once a week for a period of 6 weeks. The control group did not receive any special interventions. The data collection tool was a demographic data form and Shirom-Melamed Burnout Questionnaire (SMBQ). Burnout was evaluated as primary outcome at the beginning of the study and one month after the end of the intervention. The data were analyzed by SPSS software version 18. Results: Based on the results, there was no significant difference between the mean score of burnout in the intervention and control groups before the intervention. However, after the intervention, the mean score of burnout in the intervention group was significantly lower than that of the control group. Conclusion: Considering the positive effect of supportive-training intervention on the burnout of mothers of disabled children, this intervention is recommended by nurses and other health care providers in special schools, health centers, and supportive institutions.

The profile of Rafsanjan Cohort Study

Owning the largest human-made jungle of pistachio, the second largest copper mine, and being located on the trade route of opium transit, distinguish Rafsanjan from many other cities in Iran. The environmental exposures and lifestyle factors associated with these characteristics of Rafsanjan, have raised concern about possible health outcomes for individuals living in and around this city. Thus, local health authorities initiated the Rafsanjan Cohort Study (RCS), as part of the prospective epidemiological research studies in IrAN (PERSIAN). RCS is a population-based prospective cohort of men and women aged 35-70 years, launched in August 2015. Individuals from diverse socioeconomic levels and lifestyles were recruited from four urban and suburban areas of Rafsanjan (participation rate 67.42%). Questionnaire-based interviews regarding demographics, dietary and environmental exposures, medical and occupational history, as well as anthropometric measurements were completed for all participants. Additionally, bio-specimens (blood, urine, hair, and nail) were collected, and dental and eye examinations were performed. The enrollment phase ended in December 2017, and a 15-year follow-up is planned. A total of 9990 individuals were enrolled in RCS (53.41% females). About 26% of men are pistachio farmers. The baseline prevalence of major non-communicable disease (NCD) risk factors such as cigarette smoking, alcohol consumption and opium use were 25.45%, 10.02%, and 23.81%, respectively. The mean ± SD of other common risk factors are as follows: body mass index (27.83 ± 4.89 mm Hg), systolic blood pressure (107.18 ± 17.56 mm Hg) diastolic blood pressure (71.13 ± 10.83), fasting blood sugar (113.27 ± 39.11 mg/dL) and plasma cholesterol (198.78 ± 41.89 mg/dL). These results indicate a concerning prevalence of NCD risk factors in Rafsanjan city, warranting further detailed investigations, particularly regarding the association of NDC with agricultural/industrial pollutants and drug abuse.

Effect of Acupressure on Pain Severity in Patients Undergoing Coronary Artery Graft: A Randomized Controlled Trial

Background

Considering the contradictory results on the role of complementary therapies in correcting post-operative side effects, the aim of this study was to evaluate the effect of acupressure on pain severity in patients undergoing coronary artery graft admitted to a coronary care unit.

Methods

In this double-blind, randomized, clinical trial, 70 patients were selected randomly after coronary artery bypass grafting (CABG) surgery based on inclusion criteria and then assigned to two groups (35 in acupressure and 35 in control) randomly by the minimization method. The intervention group received acupressure at the LI4 point for 20 minutes in 10-second pressure and 2-second resting periods. In the control group, only touching was applied without any pressure in the same pattern as the intervention group. Pain severity was measured before, immediately, and 20 minutes after applying pressure and touch in both groups using the visual analogue scale.

Results

The results of repeated measures analysis of variance (ANOVA) showed a decrease in the pain score in the intervention group (group effect) during multiple measurements (time effect) and a reduction in the mean pain score in the various measurements taking into account the groups (the interaction between time and group; P = 0.001).

Conclusions

Acupressure can be used as a complementary and alternative therapeutic approach to relieve post-operative pain in CABG patients.

The effect of educating the clients of rehab centers on the frequency of methadone poisoning among children: a study from Iran

Background Poisoning with methadone is considered dangerous and fatal, which can lead to decreased consciousness, coma, apnea and eventually death. Aims The present study was conducted to evaluate the effect of educating the clients of rehabilitation (rehab) centers on the frequency of methadone poisoning among children. Methods In the present semi-experimental study, the study population included all of the clients referred to the rehab centers in an urban area of Iran who received treatment with methadone. Samples were selected using the census method. The data gathering tool was a researcher-made questionnaire of which the content validity has been approved. To perform the educational program, educational brochures were distributed among all the rehab centers (33 centers) and one face-to-face educational session was conducted at each center. Six months after the intervention, the number of under 12 year-old children who were referred to hospital with methadone poisoning was calculated and compared to the same number from the 6 months prior to the study. Data were analyzed using SPSS 18. Results According to the results, the number of methadone poisonings during the 6-month period prior to the study was 29, while the same number during the 6-month period after the intervention was 9. Fisher's exact test showed a significant difference between the number of methadone poisonings before and after the intervention (p < 0.001). Conclusion The increased level of knowledge among the parents referred to rehab centers could decrease the rate of poisoning among their children. Therefore, performing this educational program is recommended for all the rehab centers.

Evaluating the Effect of an Educational Intervention for Nursing Managers on the Rate of Incidents Reported at University Hospitals of Iran

In this semiexperimental study conducted at the university hospitals in an urban area of Iran, the number of reported incidents-as per the information from offices-was evaluated and recorded for the improvement of the quality of hospitals. Subsequently, an educational intervention was conducted for nursing managers. Three months later, the number of reported incidents was again evaluated and recorded. According to the results, the number of reported incidents increased in the hospitals after the educational intervention. The results of this study could be helpful for hospital personnel, especially nurses, to improve the culture of incident self-reporting.

The outcomes of peer-led diabetes education in comparison to education delivered by health professionals in Iranian patients

Education is an important aspect of care for diabetic patients. This study aimed to compare the effect of education by health care provider and peer on self-care behaviors among Iranian patients with diabetes. In this clinical randomized control trial, we enrolled 120 patients with type 2 diabetes who were referred to the Diabetes Clinic at a university medical center hospital in an urban area of Iran. Participants were randomly allocated into three groups. Patients in care provider group (CPG) received additional education provided by a nurse, other than routine education in a Diabetes Clinic. Patients in peer education group (PEG) received education given by a peer. Patients in control group (CG) received the routine education in accordance with the usual procedures at the Diabetes Clinic. Data collected at baseline and 12 weeks (3 months) were demographic variables and diabetes self-care activities. Self-care behaviors post intervention differed significantly by group; PEG patients demonstrated the greatest improvement. CG patients' self-care behaviors did not change significantly and were significantly lower than scores by CPG and PEG patients. In line with the World Health Organization recommendations, future studies are warranted to confirm the effectiveness of peer-led education among diabetic patients in the Iranian culture.

The effect of natural sounds on the anxiety of patients undergoing coronary artery bypass graft surgery

Background

This study aims to investigate the effect of natural sounds on the anxiety of patients undergoing coronary artery bypass graft surgery (CABG).

Methods

In this clinical trial, 90 patients, who were candidates for CABG in an urban area of Iran, were selected and randomly assigned to intervention and control groups by the minimization method. In the intervention group, natural sounds were broadcast through headphones for 30 min. In the control group, headphones connected to a silent device were used. The research instruments were a demographic questionnaire and the Spielberger State-Trait Anxiety Inventory (STAI). These were used before the intervention, 30 min after the music, and before the surgery in the waiting room for both groups. Data was analyzed using SPSS software.

Results

The mean anxiety level of the intervention group has been found to be significantly lower than that of the control group half an hour after the intervention as well as in the waiting room in the preoperative period (p = 0.001). Moreover, the mean anxiety of the intervention group decreases, while it increases for the control group over time (p < 0.001).

Conclusion

Natural sounds can be used as a non-pharmacological way to reduce the anxiety of patients undergoing CABG.

Trial registration

IRCT2017011723190N3, Registered 1 March 2017.

Application of the Betty Neuman systems model in the nursing care of patients/clients with multiple sclerosis

Objective

This study aimed to assess the application of the Betty Neuman systems model to the care of patient/clients with multiple sclerosis.

Methods

This clinical study resulted from the application of the nursing process to a patient/client admitted with multiple sclerosis in the neurological ward of a hospital in an urban area of Iran.

Results

A patient/client was evaluated according to the Neuman model. Intrapersonal stressors (physiological, psychological, socio-cultural, and spiritual), interpersonal stressors (being away from family and children) and extra-personal stressors (aggression and psychological pressure from the spouse) were found. Based on the examination, 12 nursing diagnoses based on the taxonomy of the North American Nursing Diagnosis Association International, and nursing care based on three levels of prevention that are important in the view of Neuman, are presented. The results were used in the classification of nursing interventions and the classification and nursing outcomes respectively.

Conclusions

The results suggest the desirability of care and patient/client satisfaction in the evaluation of nursing care based on the Neuman model. The model can be used as a framework to help nurses care for patients/clients. Thus, the application of this model and other models is recommended in the nursing care of patients/clients.

Challenges of teacher-based clinical evaluation from nursing students' point of view: Qualitative content analysis

INTRODUCTION

Clinical evaluation is very important in the educational system of nursing. One of the most common methods of clinical evaluation is evaluation by the teacher, but the challenges that students would face in this evaluation method, have not been mentioned. Thus, this study aimed to explore the experiences and views of nursing students about the challenges of teacher-based clinical evaluation.

METHODS

This study was a descriptive qualitative study with a qualitative content analysis approach. Data were gathered through semi-structured focused group sessions with undergraduate nursing students who were passing their 8^th semester at Rafsanjan University of Medical Sciences. Date were analyzed using Graneheim and Lundman's proposed method. Data collection and analysis were concurrent.

RESULTS

According to the findings, "factitious evaluation" was the main theme of study that consisted of three categories: "Personal preferences," "unfairness" and "shirking responsibility." These categories are explained using quotes derived from the data.

CONCLUSION

According to the results of this study, teacher-based clinical evaluation would lead to factitious evaluation. Thus, changing this approach of evaluation toward modern methods of evaluation is suggested. The finding can help nursing instructors to get a better understanding of the nursing students' point of view toward this evaluation approach and as a result could be planning for changing of this approach.

Usefulness of 360 degree evaluation in evaluating nursing students in Iran

PURPOSE

This study aimed to evaluate the clinical nursing students using 360 degree evaluation.

METHODS

In this descriptive cross-sectional study that conducted between September 2014 and February 2015, 28 students who were selected by census from those who were passing the last semester of the Nursing BSc program in Rafsanjan University of Medical Sciences. Data collection tools included demographic questionnaire and students' evaluation questionnaire, to evaluate "professional behavior" and "clinical skills" in pediatric ward. Every student got evaluated from clinical instructor, students, peers, clinical nurses, and children's mothers' point of view. Data analysis was done with descriptive and analytic statistics test including Pearson coefficient using SPSS version 18.0.

RESULTS

The evaluation mean scores were as following: students, 89.74±6.17; peers, 94.12±6.87; children's mothers, 92.87±6.21; clinical instructor, 84.01±8.81; and the nurses, 94.87±6.35. The results showed a significant correlation between evaluation scores of peers, clinical instructor and self-evaluation (Pearson coefficient, p<0.001), but the correlation between the nurses' evaluation score and that of the clinical instructor was not significant (Pearson coefficient, p=0.052).

CONCLUSION

360 Degree evaluation can provide additional useful information on student performance and evaluation of different perspectives of care. The use of this method is recommended for clinical evaluation of nursing students.

Factors Influencing Intraoperative Waiting Time According to the Experience of Iranian Families

PURPOSE

The purpose of this study was to explore factors influencing family members' experience of waiting for patients' surgery.

DESIGN

A qualitative design using content analysis approach was used.

METHODS

The study took place at a university medical center hospital in an urban area of Iran. After using a purposive sampling method for the selection of participants, semistructured interviews and field notes were held for data collection.

FINDINGS

The experience of 16 Iranian family members who were waiting for their patient's surgery to be finished was analyzed. Data analysis led to the development of three main themes: "family member-related factors," "patient-related factors," and "organization-related factors."

CONCLUSIONS

The results revealed some factors in real context that can help health care professionals, especially nurses, to get a better understanding of the situation and improve quality of care. In addition, understanding these factors will contribute to the body of knowledge in nursing.

The waiting process: a grounded theory study of families' experiences of waiting for patients during surgery

In this qualitative study, conducted with a grounded theory approach, 17 family members awaiting their relatives’ surgery, were interviewed. The interviews were semi-structured and the data from them was analysed using the constant comparative method suggested by Corbin and Strauss. The findings showed ‘attempt to reassure’ as the core category. The main theme of ‘assurance’, comprising patterns of ‘recourse to spirituality’, ‘communication’, ‘physical proximity’, and ‘coping’ indicated the processes used by participants to achieve their goals. These findings may help health care professionals, especially nurses, to better understand the subject and better facilitate the process of waiting whilst relatives have surgery.

Transplantation of ex vivo expanded cord blood cells using the copper chelator tetraethylenepentamine: a phase I/II clinical trial

The copper chelator tetraethylenepentamine (TEPA; StemEx) was shown to attenuate the differentiation of ex vivo cultured hematopoietic cells resulting in preferential expansion of early progenitors. A phase I/II trial was performed to test the feasibility and safety of transplantation of CD133+ cord blood (CB) hematopoietic progenitors cultured in media containing stem cell factor, FLT-3 ligand, interleukin-6, thrombopoietin and TEPA. Ten patients with advanced hematological malignancies were transplanted with a CB unit originally frozen in two fractions. The smaller fraction was cultured ex vivo for 21 days and transplanted 24 h after infusion of the larger unmanipulated fraction. All but two units contained <2 x 10(7) total nucleated cells (TNCs) per kilogram pre-expansion. All donor-recipient pairs were mismatched for one or two HLA loci. Nine patients were beyond first remission; median age and weight were 21 years and 68.5 kg. The average TNCs fold expansion was 219 (range, 2-620). Mean increase of CD34+ cell count was 6 (over the CD34+ cell content in the entire unit). Despite the low TNCs per kilogram infused (median=1.8 x 10(7)/kg), nine patients engrafted. Median time to neutrophil and platelet engraftment was 30 (range, 16-46) and 48 (range, 35-105) days. There were no cases of grades 3-4 acute graft-versus-host disease (GVHD) and 100-day survival was 90%. This strategy is feasible.

Microbial contamination of hematopoietic progenitor cell products: clinical outcome

We reviewed the results of routine microbiological assays of 3078 infused hematopoietic progenitor cell (HPC) products for autologous and allogeneic transplantation between January 2001 and December 2005. Thirty-seven (1.2%) contaminated products were found. All patients receiving contaminated infusions received empirical antibiotic prophylaxis according to the assay result. None of these patients developed a positive blood culture with the same agent, developed infections that could be attributable to the contaminated product or experienced any clinical sequelae. Coagulase-negative Staphylococcus was found in 32 (86.5%) products. Admission lengths and time to engraftment were within the expected time frame for autologous and allogeneic transplants. Microbial contamination of HPC products occurs at a low frequency; prophylactic use of antibiotics based on the microbiological assay appears to be effective in preventing clinical complications.

Ex vivo expansion of umbilical cord blood

The efficacy of cord blood (CB) transplantation is limited by the low cell dose available. Low cell doses at transplant are correlated with delayed engraftment, prolonged neutropenia and thrombocytopenia and elevated risk of graft failure. To potentially improve the efficacy of CB transplantation, approaches have been taken to increase the cell dose available. One approach is the transplantation of multiple cord units, another the use of ex vivo expansion. Evidence for a functional and phenotypic heterogeneity exists within the HSC population and one concern associated with ex vivo expansion is that the expansion of lower 'quality' hematopoietic progenitor cells (HPC) occurs at the expense of higher 'quality' HPC, thereby impacting the reserve of the graft. There is evidence that this is a valid concern while other evidence suggests that higher quality HPC are preserved and not exhausted. Currently, ex vivo expansion processes include: (1) liquid expansion: CD34+ or CD133+ cells are selected and cultured in medium containing factors targeting the proliferation and self-renewal of primitive hematopoietic progenitors; (2) co-culture expansion: unmanipulated CB cells are cultured with stromal components of the hematopoietic microenvironment, specifically mesenchymal stem cells (MSC), in medium containing growth factors; and (3) continuous perfusion: CB HPC are cultured with growth factors in 'bioreactors' rather than in static cultures. These approaches are discussed. Ultimately, the goal of ex vivo expansion is to increase the available dose of the CB cells responsible for successful engraftment, thereby reducing the time to engraftment and reducing the risk of graft failure.

Nucleotide excision repair genes as determinants of cellular sensitivity to cyclophosphamide analogs

The objective of this study was to determine the relative importance of the first six complementation groups of the nucleotide excision repair cross-complementing genes (ERCC1-ERCC6) and the first complementation group of the X-ray repair cross-complementing genes (XRCC1), in the repair of DNA damage induced by the in vitro active cyclophosphamide (CP) derivatives 4-hydroperoxycyclophosphamide (4HC) and phosphorodiamidic mustard (PM). We compared the sensitivity of the wild-type CHO cell line, AA8, with that of the CHO mutant cell lines UV4 and UV20 (ERCC1-), UV5 (ERCC2-), UV24 (ERCC3-), UV41 (ERCC4-), UV135 (ERCC5-), UV61 (ERCC6-), and EM9 (XRCC1-). Cell survival was determined using both growth inhibition and conventional clonogenic assays. The yield of DNA crosslinks in selected cell lines was determined using an ethidium bromide fluorescence assay.

RESULTS

The rank ordering of sensitivity to both 4HC and PM, based on the combined survival data, was UV41/UV4/UV20 > > UV61/UV24/UV135/EM9 > or = UV5 approximately AA8. Thus mutations in the ERCC1 and ERCC4 genes impart a hypersensitivity to CP analogs. To confirm the importance of the ERCC1 gene for cellular resistance to 4HC and PM, UV20 cells were transfected with the human ERCC1 gene and subsequently exposed to 4HC and PM. The transfected cells displayed essentially wild-type resistance to both drugs. Furthermore, two interspecific hybrids derived from UV41, both of which retained the region of human chromosome 16 that harbors the ERCC4 gene, displayed essentially wild-type resistance to 4HC and PM, confirming the importance of ERCC4 for the repair of 4HC-induced DNA damage. When crosslinks were assayed after a 60-min treatment with 4HC or a 15-min treatment with PM, their yield paralleled the sensitivity of the cell lines to both drugs: UV41 cells showed markedly elevated levels of crosslinks, whereas AA8 and UV5 cells showed similar (low) levels of crosslinks.

CONCLUSIONS

Our findings confirm the general pattern indicating that the ERCC1 and ERCC4 gene products are crucial for the repair of 4HC-induced DNA damage, while the other nucleotide excision repair genes examined are relatively unimportant. These data suggest that the hypersensitivity of ERCC1- and ERCC4- mutants to DNA crosslinking agents may reflect a defect in recombinational repair rather than nucleotide excision repair.

Liposome encapsulation circumvents the hepatic clearance mechanisms of all-trans-retinoic acid

All-trans-retinoic acid (ATRA) has been proven active against a range of malignancies in isolated tissue culture systems and in human clinical trials, but the duration of its effects has been transient. Recent evidence indicates that the basis for the limited duration of ATRA's activity, at least in one form of leukemia, is a pharmacological adaptation that results in reduced serum concentration after prolonged treatment. This finding suggests that an i.v. formulation of ATRA may significantly improve the potency and duration of ATRA's activity in leukemia and, potentially, other malignancies as well. Liposomal ATRA (L-ATRA) was developed to provide a formulation of this retinoic acid isomer that can be administered intravenously to provide potential pharmacological advantages over the oral formulation. When L-ATRA was administered to rats over a prolonged period, the blood levels of the drug did not change over time. In vitro studies of isolated liver microsomes revealed that catabolism of the drug was not altered in rats that were repeatedly administered the L-ATRA formulation. Whereas microsomes isolated from animals that were orally administered free ATRA the same number of times with the same doses showed a significant increase in metabolism of the drug. These results suggest that an i.v. formulation of ATRA such as L-ATRA could be extremely useful in inducing long-term remissions in patients with APL.