Research articles
Tahereh Yaghoubi; Yadollah Jannati; Mahmood Moosazadeh; Abolfazl Hosseinnataj; Fereshteh Aaraghian Mojarad
Volume 23, Issue 12 , 2021
Abstract
Background: Coronavirus disease 2019 (COVID-19) has made the grief process more complicated and brought about loads of unexpressed grief.
Objectives: The present study aimed to determine the severity of grief reactions following the death of first-degree relatives (FDRs) due to COVID-19.
Methods: This ...
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Background: Coronavirus disease 2019 (COVID-19) has made the grief process more complicated and brought about loads of unexpressed grief.
Objectives: The present study aimed to determine the severity of grief reactions following the death of first-degree relatives (FDRs) due to COVID-19.
Methods: 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 was employed 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 FDRs 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.
Results: 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 their deceased FDRs.
Conclusion: 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.
Research articles
Yuan Tang; Tian Zhang; Yan Zhang; Yue-Wen Que; Dan Lin; Dan Qiao; Xiong Tao Yang; Jia-Feng Zhao; Yu-Jin Zhang; Guo-Rong Wang; Zhao-Hui Wang
Volume 23, Issue 12 , 2021
Abstract
Aims: To detect the health?related quality of life (HRQoL) of Thyroid cancer (TC) patients and analyze the change tendency of TC patients reported symptoms after surgery.
Methods: A total of 102 TC patients who underwent thyroid surgery from September 2020 to January 2021 were enrolled in this study, ...
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Aims: To detect the health?related quality of life (HRQoL) of Thyroid cancer (TC) patients and analyze the change tendency of TC patients reported symptoms after surgery.
Methods: 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.
Results: 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.
Conclusions: 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.
Research articles
Lin Lin; Feipeng Xu; Caijin Zhou; Zhenhao Quan; Haiping Jiang
Volume 23, Issue 12 , 2021
Abstract
Background: 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.
Objectives: This study aimed to explore the role of preoperative miR-149 in nutritional screening of patients ...
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Background: 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.
Objectives: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
Research articles
Seyed Alireza Haji Seyed Javadi; Bahare Rezaei; Ali Akbar Shafikhani; Mohammad Ebrahim Sarichloo
Volume 23, Issue 12 , 2021
Abstract
Background: The Covid-19 pandemic has put unprecedented pressure on the medical staff, leading to mental disorders and burnout. Objectives: 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.
Methods: This cross-sectional ...
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Background: The Covid-19 pandemic has put unprecedented pressure on the medical staff, leading to mental disorders and burnout. Objectives: 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.
Methods: 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.
Results: Based on 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).
Conclusion: 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.
Research articles
Yahya Zeinalpour; Mahdi Kabiri; Roja Rahimi; Rahim khalilzadeh; Mehrdad Karimi
Volume 23, Issue 12 , 2021
Abstract
OBJECTIVE: 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.
METHODS: The study was conducted ...
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OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSION: 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.
Research articles
Zatul Himmah Mokhtar; Li Ping Wong; Mei Chan Chong; Abdulaziz Mansoor Al Raimi; Latifa Yahya Al Ajeel; Samira Mohajer
Volume 23, Issue 12 , 2021
Abstract
Background: Communication between cancer patients and healthcare providers plays a vital role in providing a better quality of life for cancer patients. However, it remains a debatable issue in society.
Objectives: This study aimed to determine the quality of communication (QOC) between cancer patients ...
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Background: Communication between cancer patients and healthcare providers plays a vital role in providing a better quality of life for cancer patients. However, it remains a debatable issue in society.
Objectives: This study aimed to determine the quality of communication (QOC) between cancer patients and doctors and its associated factors.
Methods: 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 communication about end-of-life care to improve communication between doctors and their patients.
Results: 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 communication was 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.
Conclusion The 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.
Case reports
Mohammad Ebrahim Kalantari; Yeganeh Azadmanesh; Ali Akbar Bagherzadeh; Hormoz Hoseinpour; Tooraj Zandbaf
Volume 23, Issue 12 , 2021
Abstract
Introduction: 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 ...
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Introduction: 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.
Case Presentation: 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 145x103/µl, hemoglobin 6.4 g/dl, platelets 15x103/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.
Conclusion: 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.
Short articles
Mahdi Gholian; Mohammad Moghzi; Mohsen Zakerian; Elham Charoghchian Khorasani
Volume 23, Issue 12 , 2021
Abstract
Dear Editor,
Since March 11, 2020, the Coronavirus (COVID-19) has been declared a global pandemic, and the World Health Organization (WHO) has declared it a public health emergency, countries have borne the brunt of the outbreak and attention has been focused on preventing the disease (1, 2). One of ...
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Dear Editor,
Since March 11, 2020, the Coronavirus (COVID-19) has been declared a global pandemic, and the World Health Organization (WHO) has declared it a public health emergency, countries have borne the brunt of the outbreak and attention has been focused on preventing the disease (1, 2). One of the most effective ways to prevent COVID-19 and control the epidemic is general vaccination, which was introduced as a key intervention against this disease (3, 4). A year after the start of the COVID-19 epidemic, a number of companies have developed a safe vaccine against COVID-19, but the lack of production of these vaccines has created problems for various countries (5).
In Iran, national vaccination began on February 9, 2021, with the priority of healthcare personnel, and gradually expanded with the priority of different vaccination groups. However, the success of vaccination depends on the general acceptance of the vaccine (5, 6). Various studies have shown that vaccination is not popular in low- and middle-income countries (4, 7-9).
With the outbreak of the delta type, it should be noted that its infectivity is more than twice that of the original strain, and the morbidity and mortality have increased. In this regard, regional and local healthcare systems have taken new steps (3). One of the cities in Iran that was affected by the COVID-19 delta virus type was Mashhad, which is located 900 km from the capital, the city has a large margin and a population of about 1,200,000 economically disadvantaged people. The mortality rate in these areas is higher than that in other areas of the city, and they are reluctant to be vaccinated.
In order to increase vaccination coverage in these low-income areas of the city, a coalition was formed between the Basij Organization and the University of Medical Sciences. By conducting need assessments, identifying existing barriers, and using facilitators, this coalition was able to create mobile vaccination bases in mosques in low-income areas to increase the vaccination coverage in such areas of Mashhad. From 14 August 2021, when the project started, to 14 September 2021, the total number of injections was 146,186, which shows a 70% increase, compared to the same period last month, when the number of injections was 86,315.
Barriers to vaccination in these areas were: 1) people's fear of vaccine side effects, 2) people's fear that the vaccine would not work, 3) extensive activity of social networks in creating reluctance in people to get vaccinated, 4) linking the corona pandemic in public opinion to divine destiny and consequently the lack of need for vaccination, 5) low level of health literacy in these areas, and 6) difficult access to fixed corona vaccination centers due to working hours of employed people.
In order to eliminate these obstacles, facilitators were used. These facilitators were 1) inter-sectoral activities: an agreement has been reached between Mashhad Medical University and the Basij Organization. The Basij Organization in Iran is a popular and widespread organization that members of the community trust and the involvement of this organization in vaccination increases people's trust; 2) appropriate technology: use of senior students and graduates of the University of Medical Sciences who have passed the specialized course of vaccination as an hourly contract, use of refrigerated cars to deliver vaccines to the injection site while maintaining and controlling the cold chain, the presence of a general practitioner at the vaccine injection site with resuscitation bags and required medications; 3) people's participation: using popular volunteer groups to carry out service activities, propaganda, inviting people and organizing; 4) easy access: vaccination close to where people live from 8 am to 6 pm even on holidays; 5) gaining people's trust: using religious places, such as mosques as a place for vaccination and specialized mobilization forces in carrying out vaccinations; 6) provision of transparent information for the people: through telephone and WhatsApp systems, using a voice machine in the area, house-to-house invitation of people to get vaccinated and encouraging them to get vaccinated; 7) usage of opinion leaders: identify opinion leaders in the region and justify these leaders to receive the vaccine, showing the vaccination of leaders on TV and social channels and their invitation to be vaccinated, asking religious speakers to encourage people to get vaccinated, the presence of experts and vaccinators in the Friday prayers of Shiites and Sunnis and the use of the tribune of these ceremonies to encourage people to get vaccinated; 8) usage of billboards and banners in suburban squares to encourage vaccinations; 9) usage of communication channels: broadcasting documentaries of activities carried out on the outskirts of Mashhad on television, informing through provincial news, forming channels on social media to answer doubts about vaccination, setting up a telephone system and using faculty and expert members of the University to respond online to vaccine suspicions, and face-to-face contact with people about vaccines; 10) usage of health literacy strategies, such as using a simple and understandable language when educating people, rather than using professional jargon; 11) diversification of vaccines and use of vaccines available in the country; 12) creation of an Android application for electronic health records for the online registration of vaccinations; and 13) vaccination of non-Iranian citizens living on low-income areas of the city.
Conclusion
Vaccination is the most effective way to control the COVID-19 epidemic. In order to increase the coverage of COVID-19 vaccination in low-income areas of Mashhad, a coalition was formed between the Basij Organization and the University of Medical Sciences. Barriers to vaccination were people's fear of the side effects of the vaccine, the ineffectiveness of the vaccine, the widespread activity of social networks in creating a reluctance to get vaccinated, and people's misconceptions. Facilitators were used to overcoming these barriers, which are: inter-sectoral activities, usage of appropriate technology, easy access, provision of transparent information and gaining people's trust, support of religious leaders, effective use of communication channels, use of health literacy strategies, and diversity. Finally, by taking these measures, the number of vaccinations in low-income areas of Mashhad will increase by 70% in 1 month, which can be considered as a model for similar areas.
Research articles
Somayeh Fazaeli; Mehdi Yousefi; Mohadeseh Sabethoseini Dokht
Volume 23, Issue 12 , 2021
Abstract
Background: The ongoing coronavirus disease 2019 (COVID-19) pandemic increased the need for inpatient beds, indicating the need for hospitals to increase the efficiency of beds.
Objectives: This study aimed to increase hospital bed capacity using the implementation of Electronic Patient Discharge (EPD).
Methods: ...
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Background: The ongoing coronavirus disease 2019 (COVID-19) pandemic increased the need for inpatient beds, indicating the need for hospitals to increase the efficiency of beds.
Objectives: This study aimed to increase hospital bed capacity using the implementation of Electronic Patient Discharge (EPD).
Methods: 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.
Results: 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%.
Conclusion: 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.
Research articles
Samira Mohajer; Li Yoong Tang; Mei Chan Chong; Mahmoud Danaee; Seyyed Reza Mazlum; Nasser Bagheri
Volume 23, Issue 12 , 2021
Abstract
Background: Professional self-concept (PSC) is an important issue concerning the nursing profession and is reflected as the key concept in nursing professionalism. Although previous studies investigated this concept and its related factors among nursing students, their results showed no consensus.
Objectives: ...
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Background: Professional self-concept (PSC) is an important issue concerning the nursing profession and is reflected as the key concept in nursing professionalism. Although previous studies investigated this concept and its related factors among nursing students, their results showed no consensus.
Objectives: This study aimed to assess PSCs among senior nursing students and examine their relationship with gender and Grade Point Average (GPA).
Methods: 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, Mashhad, Iran. The data were collected using Cowin's 36-item Nursing Professional Self-Concept questionnaire, which measures nursing self-concept in six dimensions.
Results: Undergraduate nursing students were 22-24 years old (22.58±98). Moreover, two-thirds of the students were female (66%) and married (71%). The nursing students reported a total mean score of PSC to be 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). In addition, there was no significant difference among gender, total PSC, and its dimensions, and there was no relationship with GPA, except for the staff relations (r=-0.198, P<0.05) and leadership (r=-0.210, P<0.05), which showed a negative and significant correlation; however, the correlation coefficients were not strong (P<0.3).
Conclusion: Due to a moderate level of total PSC and the lowest dimensions in self-esteem among nursing students, it is recommended that nursing students' PSC and its dimensions, specifically in self-esteem, be taken into account, which can boost their nursing professionalism.
