Research articles
Mehmet Kadir Bartin; Arzu Esen Tekeli; Gokalp Okut; Esra Eker; Muzaffer Onder Oner
Volume 24, Issue 6 , 2022
Abstract
Background: Retrosternal goiter surgery is a technically challenging procedure. Selecting the appropriate surgical approach is critical in preventing surgical and anesthesia complications.
Objectives: This retrospective clinical study aimed to investigate the role of thyroid volume and weight in the ...
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Background: Retrosternal goiter surgery is a technically challenging procedure. Selecting the appropriate surgical approach is critical in preventing surgical and anesthesia complications.
Objectives: This retrospective clinical study aimed to investigate the role of thyroid volume and weight in the development of retrosternal goiter and the importance of special anesthesia management in patients with retrosternal goiter, which is a potentially difficult airway candidate.
Methods: Retrosternal goiter was detected in 125 patients through ultrasonography. Patients were divided into cervical surgery (CA) and sternotomy (ECA) groups. Volumetric measurements were performed ultrasonographically. Patients' demographics, preoperative thyroid ultrasonography features, American Society of Anesthesiologists (ASA) classifications, Mallampati classifications, intubation characteristics, perioperative and postoperative patient data, and postoperative thyroid specimen weights were recorded.
Results: A total of 106 patients (32 male and 74 female) were operated on for bilateral total thyroidectomy. Total thyroidectomy was performed with CA in 98 (92.5%) patients and with ECA in 8 (7.5%) patients. Malignancy was detected in 4 (3%) of 106 operated cases. All of the malignant cases were seen in patients with a cervical approach. When the volumetric measurements of both groups were compared, the volume values were significantly higher in the ECA group (P=0.032).
67 patients were ASA I and 39 patients were ASA II. 64 patients were defined as Mallampati Class I, 36 patients as Mallampati Class II, and 6 patients as Mallampati Class III. Intubation was performed on the third attempt for 5 patients and 8 patients with Mallampati I and Mallampati II, respectively. The rate of difficult intubation was statistically significant in the ECA group (P=0.019).
Conclusion: Predicting ECA requirement in the preoperative period is closely related to the preoperative volumetric analysis of the thyroid gland with three-dimensional ultrasonography. In addition, since anesthesia management is difficult in patients who need ECA, volumetric analysis has become even more critical.
Research articles
Mitra Payami Bousari; Parisa Jahangiri; Zeinab Ghahremani
Volume 24, Issue 6 , 2022
Abstract
Background: Effective communication is considered a key factor affecting patients and their family satisfaction. The Therapeutic Communication Helping Model (TCHM) facilitates comprehensive care delivery by focusing on effective communication.
Objectives: Evaluate the effects of nursing care based on ...
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Background: Effective communication is considered a key factor affecting patients and their family satisfaction. The Therapeutic Communication Helping Model (TCHM) facilitates comprehensive care delivery by focusing on effective communication.
Objectives: Evaluate the effects of nursing care based on the Therapeutic Communication Helping Model (TCHM) on patient and family satisfaction in the coronary care unit (CCU).
Methods: This quasi-experimental was conducted based on the posttest-only design between June and October 2017 in the Educational and Treatment Center of Mousavi in Zanjan, Iran. In this study, the time sequence sampling method was used. A total of 58 patients and 58 family members from CCU with inclusion criteria were included through the convenience method in each sequence as the control and intervention groups. One week after the end of the control group sampling, the sampling of the intervention group began. In the meantime, a 4-hour workshop was conducted twice for the ward nurses to get acquainted with TCHM. Trained nurses provided holistic nursing care based on TCHM for patients (n=58) and their family members (n=58). Data were collected using the Patient Satisfaction Instrument, and the Family Members Satisfaction Questionnaire for adult patients. The satisfaction rate of both control and intervention groups were assessed at the time of discharge. Data were analyzed using the Chi-square test, independent t-test, and paired t-test in the SPSS software (version 22) at the significance level of 0.05.
Results: The mean scores of patient and family satisfaction were respectively 3.47±0.84 and 3.91± 0.67 in the intervention group. In the control group, these values accounted for 3.14±0.5 and 3.20±0.78, respectively. The mean scores of patient and family satisfaction and their subscales in the intervention group were significantly greater than those in the control group (P<0.05).
Conclusion: The TCHM significantly improved patient and family satisfaction. It is suggested that by incorporating this model into nursing practice the delivery of care will be enhanced.
Research articles
Mehmet Onur Gul; Cagla Bali
Volume 24, Issue 6 , 2022
Abstract
Background: Sarcopenia may adversely affect treatment responses and oncological outcomes in cancer patients. However, the importance of pretreatment nutritional assessment as an indicator of treatment response and outcome in patients with gastric cancer undergoing neoadjuvant chemotherapy remains unclear.
Objectives: ...
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Background: Sarcopenia may adversely affect treatment responses and oncological outcomes in cancer patients. However, the importance of pretreatment nutritional assessment as an indicator of treatment response and outcome in patients with gastric cancer undergoing neoadjuvant chemotherapy remains unclear.
Objectives: This study aims to investigate the clinical impact of sarcopenia on gastric cancer and to determine the effect of neoadjuvant chemotherapy (NC) on sarcopenia, as well as body mass index (BMI), psoas muscle index (PMI), and prognostic nutrition index (PNI).
Methods: A retrospective review was performed on patients with gastric adenocarcinoma who were operated on after the NC therapy between January 2016 and December 2019. Weight, BMI-, PMI-, and PNI-dependent variables were compared before and after the NC treatment. Sarcopenia was defined according to PMI at the level of the third lumbar vertebra based on computed tomography.
Results: Forty-five patients (64.4% women) with a mean age of 56.9±11.2 years were included in the study. After the NC treatment, the mean BMI of the cohort decreased from 26.1±4.3 kg/m2 to 25.1±4.2 kg/m2, the mean PMI decreased from 5.69±1.39 cm2/m2 to 5.16±1.50 cm2/m2, and the mean PNI decreased from 46.6±6.5 to 40.0±7.0 (All, P<0.001). The NC treatment increased the frequency of sarcopenia from 48.9% to 64.5% (P<0.001).
According to the Clavien-Dindo (CD) scoring, grade >3 CD complications were more common in the sarcopenic group (27.2%), compared to the non-sarcopenic group (8.7%) (P=0.049). The one-year and three-years overall survival rates were lower in the sarcopenic group (91.7% and 38.2%, respectively), compared to the non-sarcopenic group (93.8% and 45.8%, respectively). However, it was not statistically significant (P=0.509).
Conclusion: Sarcopenia is associated with severe postoperative complications in gastric cancer. In addition, the NC treatment reduces PMI, BMI, as well as PNI, and increases sarcopenia frequency. Therefore, patients should be examined in terms of sarcopenia at the time of diagnosis.
Research articles
Fayegh Abdolahzadeh; Mahmoudreza Peyravi; Pirhossein Kolivand; Hossein Bagherian; Nahid Tavakoli
Volume 24, Issue 6 , 2022
Abstract
Background: Effective communication and timely information exchange during disasters and emergencies can help the responsive organizations prepare better and react rapidly and effectively in order to mitigate losses and casualties.
Objectives: This study summarizes the experiences of experts at Irans ...
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Background: Effective communication and timely information exchange during disasters and emergencies can help the responsive organizations prepare better and react rapidly and effectively in order to mitigate losses and casualties.
Objectives: This study summarizes the experiences of experts at Irans Relief and Rescue Organization and Emergency Organization with regard to how communication and information exchange contributed in response to the past disasters.
Methods: The content analysis approach was used in this qualitative study. The statistical population included the operational managers and employees of Irans Relief and Rescue Organization and Emergency Organization from different provinces with various in managerial and field work's experiences at high, middle, and operational levels as well as experiences with local, provincial, regional, national, and international disasters. The purposive sampling method was employed to collect data through semi-structured interviews with 24 participants. Data analysis was performed in MAXQDA 12.
Results: The results of analyzing the interviews extracted a main theme of communication and information exchange with two categories. The first category was identified as intra-organizational communication and information exchange with seven subcategories called organizational individuals and departments, communication channels, communication model, message content, purpose of communication, standards and instructions, and challenges. The second category was identified as inter-organizational communication and information exchange with six subcategories called organizational individuals and departments, communication channels, communication model, message content, purpose of communication, and challenges.
Conclusion: The participants believed that there were limited horizontal communications and information exchange between Irans Relief and Rescue Organization and Irans Emergency Organization at the same level via fixed phones, mobile phones, and wireless radios in response to disasters. Therefore, disturbance to accurate timely communication and information exchange between organizations, especially in the first 24 hours of a disaster and lack of inter-organizational agreements and communication infrastructure result in the further vulnerability of victims, Red Crescent rescuers, and emergency technicians.
Research articles
Soraya Malekzadeh; Mei Chan Chong; Li Yoong Tang; Negar Omidi; Mahmoud Danaee
Volume 24, Issue 6 , 2022
Abstract
Background: Cardiac syndrome X (CSX) is a form of ischemic heart disease with functional coronary microvascular abnormalities. The symptoms are often debilitating and sufferers have a poor quality of life, with costly demand for healthcare services. Therefore, an educational intervention contributes ...
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Background: Cardiac syndrome X (CSX) is a form of ischemic heart disease with functional coronary microvascular abnormalities. The symptoms are often debilitating and sufferers have a poor quality of life, with costly demand for healthcare services. Therefore, an educational intervention contributes to the increase of knowledge about CSX risk factors and adherence to a healthy lifestyle.
Objectives: This study aimed to investigate the effectiveness of educational interventions on knowledge and adherence to a healthy lifestyle in CSX Patients.
Methods: A simple, two-arm, parallel, randomized control trial was conducted in the Heart Clinic on 100 CSX outpatients who were selected through randomized sampling and divided into experimental (n=50) and control (n=50) groups. This study assessed an educational program that has been provided through the Mobile Health application (mHealth app) to the experimental group. The data were collected using the Heart Disease Fact Questionnaire (HDFQ) and Adherence to a Healthy lifestyle questionnaire (AHLQ).
Results: In the intervention group, the difference between the pre-test and post-test mean scores of knowledge on CSX risk factors was statistically significant (SD=1.77; P<0.05). However, there was no significant difference between pre-test and post-test means scores in the control group (SD=3.12; P>0.05).
Conclusion: Patients with CSX have high morbidity and health care expenditure; therefore, the provision of an educational program through the mHealth app as well as lifestyle modification can be considered a highly effective and low-cost intervention contributing to an increase of knowledge about CSX risk factors in patients and adoption of a healthy lifestyle.
Research articles
Yaser Moradi; Rahim Baghae; Aram Feizi; Reza Hajialibeigloo
Volume 24, Issue 6 , 2022
Abstract
Background: Despite the introduction of e-learning in recent years, it has not been utilized as a major educational method in numerous universities, especially in the area of medical and health sciences, until the crisis of the COVID-19 pandemic.
Objectives: This study aimed at explaining the strengths ...
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Background: Despite the introduction of e-learning in recent years, it has not been utilized as a major educational method in numerous universities, especially in the area of medical and health sciences, until the crisis of the COVID-19 pandemic.
Objectives: This study aimed at explaining the strengths and weaknesses of asynchronous e-learning in nursing education throughout the COVID-19 crisis.
Methods: In this qualitative descriptive study, a total of 14 nursing faculty members were selected using the purposive sampling method. The interviews were conducted face-to-face with semi-structured questions. The researcher recorded all interviews with the participants' consent. Data analysis was conducted in four phases using the content analysis approach (Graneheim and Lundman).
Results: Nursing faculty members cited "low quality of educational content", "cold and soulless education", "low efficiency in clinical education", and "insufficiency in educational assessment process" as the weaknesses and "maintenance of safe education during the COVID-19 crisis" as the strength of asynchronous e-learning in nursing education during the COVID-19 crisis.
Conclusion: Asynchronous e-learning was shown to have various weaknesses in nursing theoretical and clinical education. However, the most striking strengths of this method in the COVID-19 pandemic were found to be the protection of the safety and health of individuals, followed by the maintenance of academic activities and education. Therefore, it is worthwhile for all nurse researchers, academic education policy-makers, and faculties to put conscious effort into developing standard protocols for the preparation of educational content, empowering lecturers in the area of online education, and using other methods to promote dynamic interactions.
Review articles
Farzan Madadizadeh; Sajjad Bahariniya
Volume 24, Issue 6 , 2022
Abstract
Context: Statistical methods as a complement to biomedical research have a major role to play in the design, management, analysis, and interpretation of scientific data. The present study aimed to determine the statistical methods, time-to-acceptance, and the associated factors in articles published ...
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Context: Statistical methods as a complement to biomedical research have a major role to play in the design, management, analysis, and interpretation of scientific data. The present study aimed to determine the statistical methods, time-to-acceptance, and the associated factors in articles published in the Iranian Red Crescent Medical Journal (IRCMJ).
Evidence Acquisition: Original articles in the period 2014 to 2021 from volumes 16 to 23 and issues 1 to 12 were assessed (1,300 articles). Each article was assessed by a two-member team consisting of a statistician and an expert researcher in the field of medical research. Statistical methods, sample size, sampling method, statistical population, study design, and software were extracted. Frequency, Percentage, Median, Interquartile range, Multiple response analysis (MRA), Kruskal-Wallis test, and Spearman correlation coefficient were used for data description and analysis, respectively. All analyzes were performed in SPSS software (version 26) at a significance level of 5%.
Results: The statistical population of most published articles was related to patients (n=547; 41.2%). Most studies (n=565; 43.5%) had a sample size between 100 and 500 people. The majority of them were analytical interventions (n=535; 41.2%). The median (IQR) of the acceptance period was 94 (58-153.75) days. The results of MRA demonstrated that both among the total tests and the articles, the highest rate of statistical methods was related to the T-test, Chi-square test, and descriptive statistics. There was no statistically significant factor influencing the acceptance period (P>0.05), and no significant correlation was detected between the acceptance period and the sample size of published articles (r=-0.04; P=0.625).
Conclusion: The acceptance period is a key factor academic researchers should consider when selecting an academic journal for their research paper. Contrary to some novice researchers' beliefs, the acceptance period of the article was not affected by the design, statistical methods, and sample size of the study.
Letter to Editor
Majid Taati Moghadam
Volume 24, Issue 6 , 2022
Case reports
Maryam Sarkardeh; Amin Dalili; Poorya Etesamyzade; Ali Shamshirian; Zahra Sadrzadeh; Javad Kooshki; Maryam Khoshdast; Alireza Rezapanah
Volume 24, Issue 6 , 2022
Abstract
Background: By the end of May 2021, 170 million cases and 3.54 million death from Covid-19 infection have been reported. The high affinity of virus particles to ACE-2 receptors in different body organs can cause varied clinical manifestations and complications. Ischemic colitis and necrosis are some ...
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Background: By the end of May 2021, 170 million cases and 3.54 million death from Covid-19 infection have been reported. The high affinity of virus particles to ACE-2 receptors in different body organs can cause varied clinical manifestations and complications. Ischemic colitis and necrosis are some rare complications of Covid-19 infection with high morbidity and mortality resulting from colonic hypoperfusion. Different underlying mechanisms for ischemic colitis in Covid-19 patients have been described, including hypercoagulable state, inflammatory responses, microthrombosis, and non-occlusive intestinal ischemia due to shock, hypoxemia, and low cardiac output.
Case Presentation: here, we presented three patients with ischemic colitis and one rectal necrosis as a rare presentation of gastrointestinal complication of SARS-CoV-2 infection. All of our patients presented with abdominal pain and tenderness and received a standard regimen of antibiotics, anticoagulation, and ventilation support.
Conclusion: Ischemic colitis is one of these rare but with high mortality manifestations, which presents with non-specific signs and symptoms. Hence, ischemic colitis should be kept in mind in patients with Covid-19 infection and abdominal pain, which necessitates further evaluations.
Letter to Editor
AmirAli Moodi Ghalibaf; Mina AkbariRad; Mehdi Ataee Karizmeh
Volume 24, Issue 6 , 2022
Abstract
In late December 2019, the novel coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first presented in the Hubei province of China as pneumonia of unknown cause, which has caused millions of deaths up to now (1). Studies indicated the most common ...
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In late December 2019, the novel coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first presented in the Hubei province of China as pneumonia of unknown cause, which has caused millions of deaths up to now (1). Studies indicated the most common signs and symptoms of the conventional COVID-19 variants as fever, cough, dyspnea, and fatigue. In advanced stages, this mysterious viral disease leads to acute respiratory distress syndrome, acute cardiac damage, as well as gastrointestinal manifestations (2).
In late 2021, the emergence of the new COVID-19 variant, called the Omicron variant, started a new global pandemic wave and was stated as a "version of concern (VOC)" by the World Health Organization (3). Despite our little knowledge about the COVID-19 Omicron variant, some evidence presented the milder manifestation of this new variant than the previous variants, probably due to the global vaccination effects. However, few new theories and studies indicated the life-threatening aspects of the Omicron variant (3).
As indicated in our previous study, cancer patients are in danger of COVID-19 (4); however, seemingly, the Omicron variant has made a novel situation for these patients. Therefore, in the present study, the authors briefly investigated whether the COVID-19 Omicron variant is threatening cancer patients or not?
Cancer Patients in the COVID-19 Era
Most cancer patients are at an exceptionally high risk of infection with the SARS-CoV-2 with probably higher morbidity and mortality rates, prompting special attention to this populace. Molecular links between most cancers and the COVID-19 have been observed to be related to Angiotensin-Converting Enzyme 2, Transmembrane Protease Serine 2, pro-inflammatory cytokines, and blood coagulation (5). Some anticancer agents are being investigated as a possible treatment for the COVID-19. Based on these findings, new therapeutic options are designed for the treatment of both cancer and the COVID-19. They can manage the extreme outcomes of the COVID-19 and have therapeutic effects on many active cancers (2,5). On the other hand, some investigations have proposed the theory of the COVID-19 associated cancer incidence (4,5). Therefore, according to what is stated and considering the immune-suppressed situation of cancer patients, it is highly advised that clinicians who encounter SARS-CoV-2 infected cancer patients pay special attention to their treatment and follow-up.
Omicron Variant: Danger for Cancer Patients or Not?
The latest findings of the COVID-19 Omicron variant determined its new immune-escape properties, which can potentially enable the virus to infect vaccinated individuals or re-infect anyone (6). Furthermore, these investigations indicated that this VOC has higher transmissibility among people than the Delta and Beta variants. Additionally, its doubling time is approximately one-third of the two other mentioned variants (6). Therefore, due to increased infections, transmissibility, and immune escape, this new VOC has made an alert for healthcare workers and clinicians to severely take care of cancer patients, as an in-danger group. In detail, some of the major reasons and recommendations are as follows (Figure 1):
1- Cancer Patients Vaccination: Based on molecular and serological studies, the serum anti-SARS-CoV-2 S (anti-S) titer has a lower median after two doses of vaccination in cancer patients, compared to the general healthy population. Previous research findings proposed that all cancer patients should receive the third dose of the vaccine three to four months after the second one (7). While receiving the third dose of the COVID-19 vaccine is necessary for all cancer patients, there are controversies about the fourth dose for these patients. Although administrating dose four is probably not highly efficient in cancer patients due to their anti-CD20 treatment, some scientific tips state that the fourth dose can be administrated four months after the last dose in developed countries (7,8).
2- Cancer Patients' Relatives Vaccination: It is highly recommended by scientific studies and societies that relatives of anyone, due to their close contact, could act as a virus transporter. It is advised to administer the third dose for those in contact with cancer patients approximately four months after the second one. Moreover, vaccination of 5-11 years old children, as silent transporters, seems highly important (8).
3- Behavioral Prophylaxis: Scientific studies have approved that the COVID-19 is transmitted through air and droplets. Therefore, it is essential that immune-suppressed people, especially patients with active malignancy, do not gather in populated communities and events. Furthermore, wearing highly protective masks is highly crucial not only for cancer patients but also for everyone else (9).
4- Monoclonal Antibody Prophylaxis: Monoclonal antibody prophylaxis and treatment is not approved for COVID-19 medication. However, some in vitro documents indicated its efficacy on the Delta variant, while this neutralization effect is lower on the Omicron variant. Nevertheless, there is a high controversy about applying monoclonal antibodies for COVID-19 prophylaxis even in cancer patients (10).
In conclusion, although cancer patients have been in danger of COVID-19 infection and its complication, the new Omicron variant needs more attention and protection. It is highly advised that clinicians and cancer patients take the Omicron variant seriously. Complete vaccination, the administration of the third and even the fourth dose, as well as behavioral prophylaxis, are major routes to being safe beyond the other ways to be protected in the COVID-19 Omicron era.
Systematic reviews
Thalwaththe Gedara Nadeeka Shayamalie Gunarathne; Tang Li Yoong; Khatijah Lim Abdullah; Nishantha Nanayakkara; Lim Soo Kun; Samira Mohajer
Volume 24, Issue 6 , 2022
Abstract
Context: Stress is a common comorbid disorder among hemodialysis patients, and diverse factors contribute to stress perception in such individuals. Although numerous findings have been consistent across the literature, there has been a lack of consensus on which factor is the most influential on stress ...
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Context: Stress is a common comorbid disorder among hemodialysis patients, and diverse factors contribute to stress perception in such individuals. Although numerous findings have been consistent across the literature, there has been a lack of consensus on which factor is the most influential on stress perception. This systematic review aimed to provide an executive review on factors contributing to stress perception among hemodialysis patients.
Evidence Acquisition: A detailed search was carried out on Cumulative Index to Nursing and Allied Health Literature, PubMed, EBESCOhost, Google Scholar, Medline, and Web of Science databases. Rigorous search narrowed to 16 observational studies (n=3,567 participants) on factors determining stress perception among hemodialysis patients. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline was incorporated. The selected 16 articles were used in the qualitative synthesis.
Results: Stressors were grouped as biological, psychological/behavioral, or social/environmental factors. It was revealed that the effects of socio-demographic factors on stress perception were scarce and inconsistent, while fatigue and itching were distressing biological factors. Limitations on time and place on vacation, limitation of food and fluid are psychological stressors and decrease in social life with substantial economic burden were enlightened as social stressors.
Conclusion: Multidisciplinary factors were found for stress perception among hemodialysis patients. Nursing care plans should address the holistic nature of stress with appropriate nursing interventions. Although this review adopted the strict selection criteria, it remains difficult to conclude determinants due to methodological drawbacks. Therefore, future research in this scope is highly appreciated with prospective longitudinal nature to produce solid clinical conclusions.
