محمد گلی طالب

Methotrexate is an important drug for treatment of rheumatoid arthritis (RA) but is associated with adverse side effects on liver. In this study we evaluated the effect of silymarin on methotrexate induced hepatotoxicity and its analgesic effects in the patients taking this drug.

This study inclouded 58 patients with RA. Patients who had been treated with 2.5 mg methotrexate three times a week for six months were randomly divided into two groups of A and B. Group A received methotrexate and group B treated with 280 mg of silymarin tablets daily (two doses for 2 months) in addition to methotrexate. At baseline (before tests) and after two months, both groups completed the VAS (Visual Analogue Scale) questionnaire and Cr (Creatinine), BUN (Blood Urea Nitrogen), ESR (Erythrocyte Sedimentation Rate), Hemoglobin, WBC (white blood cell), PLT (Platelet) and the liver tests including ALT (Alanine Transaminase) and AST (Aspartate Aminotransferase) were evaluated. We used t-test for data analysis.

In the group B, ALT, AST and ESR, Cr and BUN decreased significantly. Also clinical signs of pain which were indicative of pain intensity were decreased.

Use of silymarin in the patients with RA reduced liver enzymes, liver toxicity and renal complications, which may be due to its antioxidant and cell membrane stabilization properties.

Because of the relationship between clinical competency and quality care concept, clinical competency in nursing, as a practical discipline, has a unique status. On the other hand, one of the most important challenges of nursing management for promotion of quality of nursing services is to improve nurses’ occupational quality of life. Therefore, the aim of this study was to evaluate the impact of promoting nurse's clinical competency on the occupational quality of life in pediatric nurses.
This study was a quasi-experimental, before, and after study that was done on 62 pediatric nurses at selected Hospital of Shahid Beheshti University of Medical Sciences. First nurse's clinical competency and occupational quality of life was measured. For evaluation of nurse's clinical competency, a check list was used. Sixteen skills were evaluated to assess the clinical competency of nurses. Thus, nurses were observed 3 to 5 times. Occupational quality of life was evaluated by the questionnaire. Then, in five meetings that lasted two hours, the process of educating about child and family was trained to the nurses. After 3 months, nurse's clinical competency and occupational quality of life were evaluated. Data were analyzed by the SPSS 21, using descriptive statistics and paired t-test at significance level of P = 0.05.
Before the intervention, level of clinical competency of all nurses was at a medium and low level. After the intervention, clinical competency of 93.5% of the nurses was promoted from the low level to the medium level. There was a significant difference between mean clinical competency before and after the intervention. Before the intervention, the majority of nurses (66.1%) had medium occupational quality of life. After the intervention, occupational quality of life of most nurses (75.8%) was reported as medium. There was a significant difference between the mean occupational quality of life before and after the intervention.
Promoting clinical competency, even in a scope, improves occupational quality of life. For this reason and regarding the mission of clinical governance at health centers and providing more safety and quality of care provided to patients, it is recommended to promote clinical competency by planning for a period of continuing medical education, as a program to be carried out annually.

March medicinal plant with the scientific name of Peganum harmala L., is considered as herbaceous species which is traditionally used as an antimicrobial drug in the treatment of infectious diseases. This study aimed to compare the antimicrobial effect of Peganum harmala smoke and hydrogen peroxide solution on the microbial load in the hospital wards.
This study was a trial study done in indifferent parts of a teaching hospital. Two trolleies were collected from each ward of the hospital, then a primary culture samples were taken. The sample were divided into two halves. One was disinfeted with smoke harmala (10gr/m3) and the other with Hydrogen peroxide. After the appropriate time, the re-sampling was carried out on blood agar and Mac Cancan. The results were analyzed using the software SPSS16.
The results showed that hydrogen peroxide had some antimicrobial effects on staphylococs and gram-positive, and Peganum harmala smoke had the effects on the gram-negative bacilli. Chi-square test revealed no differences in their antimicrobial effects between Peganum harmala smoke and Hydrogen peroxide solution.
Since Peganum harmala smoke can be as effective disinfectant as hydrogen peroxide in their properties, and regarding its effects on the Gram-negative bacilli, it can be used as an auxiliary disinfectant in the theraputic wards.

Today, from the viewpoint of nursing ethics, maintaining the privacy of patients as a part of patient rights is the base and foundation of caring for the patient. Therefore, the present study was done with the aim of evaluating the extent to which the privacy of patients hospitalized in emergency department (ED) is maintained.
This cross-sectional study was carried out in EDs of educational hospitals in Arak, Iran. Convenience sampling was used to include patients hospitalized in ED. The tool used for data gathering was a valid and reliable questionnaire that consisted of demographic data as well as 25 questions to assess the physical, informational and mental-social aspects of patient privacy. Gathered data were analyzed with SPSS software version 16.
In the end, data extracted from 300 patients with the mean age of 41 ± 7.22 years were evaluated (60% male). Among the studied patients 62.2% of the participants rated the maintenance of their privacy as poor and only a few (1.7%) of them rated their privacy maintenance as good. In the present study, maintaining the privacy of the patients had a significant correlation with age (p = 0.04), marital status (p = 0.04), and level of education (p = 0.03).
Based on the results of the present study, it seems that from the patients’ point of view, maintenance of their privacy by the staff is poor in the studied centers.

Occupational violence increasingly has been known as a problem in health care system. Emergency personnel, because of direct contact with patients and their relatives are exposed of the most invasions. Multiple refers to emergency unit than other hospital parts increase threat occurrences, physical and verbal violence and cause to physical and mental injury in medical personnel. In Gerberich et al viewpoint, working in ICU (intensive care unit), psychological and emergency unit is of important factors for exposure of violence. This study aims to determine the vulnerable factors of occupational violence against practitioner medical personnel in the emergency units of training hospitals of Arak city.
In this descriptive-sectional study, 108 of practitioner medical personnel of the emergency units were studied in verbal and physical violence in 1394. Studied society were practitioner medical personnel of emergency unit of training hospitals of Vali-Asr, Amir- Almumenin and Amir-Kabir of Arak. Entry measures were self-desire of personnel in all educational levels and occupational grades with one year work experience in current unit in turning shift. In order to collect information of violence in work place questionnaire in health units were used which include four parts (demographic information, threat, verbal and physical violence). This questionnaire is derived from standardized questionnaires of international labor office, WHO, international council of nurses, public services international which are balanced based on environmental and social conditions and its reliability and validity were confirmed. Data were analyzed by SPSS software version 21.
Ethical Considerations: This paper is a part of issued investigational plan of medical sciences of Arak University, by ethical committee confirmation of IR.ARAKMU.REC.1394.148. The goal of study was explained for participants and secrecy and anonymity were ensured to them. Also, verbal satisfaction was obtained from medical personnel for contribution in study.
Findings: Participants had average age of 31.45±6.26 years, total work experience mean 6.85±5.09 years and work experience mean 3.49±3.22 years in emergency unit. 28.7% of medical personnel were exposed of physical violence and 77.1% of them were exposed of verbal violence. 17.9% of participants reported verbal violence very much, 20.2% moderate and 36.9% low or very low. The most motivating reason of violence was crowdedness of unit and the most factors resulted to physical and verbal violence was patient's relatives. The most physical violence factor (856.4%) and verbal (60.5%) were for relatives.
Findings showed high prevalence of violence, especially verbal violence against medical personnel. According to occupational characteristics of practitioner personnel in emergency unit, it can be said that violence emergence in work place is inevitable and impossible work. Therefore, the best approach is to identify amount and vulnerable factors in regions violence and to program for reducing its occurrences as low as possible. It should be noted that workplace violence is a multidimensional problem which its destructive dimensions has adverse effects on emergency personnel performance and also on hospital performance. Thus, creating a supportive environment, preparing continual training programs, financial resources and enough human force, restricting visit hours, also observation and answering in patients care are recommended in order to successful performing care programs. In this study, violence was forced from patient relatives more which can be prevented by managing, planning and public training.

Myocardial infarction is one of the main causes of death and disability in the world. Adherence of therapeutic regimen is an important caring option in these patients. This study has been conducted to determine the effect of family-centered education on laboratory index of patients after acute myocardial infarction.
This clinical trial was performed between October and March 2014 in CCUward of Amirkabir hospital of Arak. Research samples were 60 patients with 30-70 years old who had been selected by convenience method after the first heart attack and randomly assigned into two groups: control (patient-centered education: 30 individuals) and intervention (family-centered education: 30 individuals). On admission, blood sugar and blood lipids (Chol, TG, HDL, LDL) were examined. Theneducation to patients was done in the intervention group associated with close family member through computers in three domains (diet, pharmaceutical regimen and exercise program) in three sessions of 30-45 minutes and the same educational content were taught to the patient (without family members) in the control group. Three months after the intervention, all aforementioned items were recorded again in two groups and, finally, data were analyzed using independent t-test and Chi-square test.
The results indicated that laboratory indexincluding blood sugar (P=0.03), blood lipids (P=0.0001) in the family-centered group was better than patient-centered group. However, there was not a significant difference between the two groups in aforementioned items before the intervention (P> 0.05).
According to the findings of this study, it seems that family-centered education model improves laboratory index of the patients with myocardial infarction. It is recommended that the educational interventions for the patients with myocardial infarction to be done with the participation of the family.

Due to the growing complexities of health care, the use of methods that improve the ability to think critically, decision-making and problem-solving in nursing is mandatory. This study aimed to determine the effect of inquiry-based learning on student's performance skills, satisfaction and clinical environments. This study was carried out with the aim of determining the effect of inquiry-based teaching on student's operational skills and satisfaction in clinical environments.
This clinical trial was conducted in the ICU unit of Valie Asr hospital of Arak in 2014. A total of 40 nursing students were selected through census method and randomly divided into two 20-member groups. After the pre-test, students in the control group and those in the intervention group received conventional (traditional) and inquiry-based training for 10 days, respectively. At the end of training, both groups took post-test. Finally, independent and paired-t and chi-square tests and using SPSS.V16 software were analyzed.
The results showed that there was no significant difference between the two groups in clinical skills prior to training. But after the intervention, the intervention group scores in the areas of clinical skills such as arterial blood sample preparation (P=0.0001), connection to ventilator (P =0.0001), suction (P =0.0001), tube feeding stuffs (P =0.001) and skin care (P =0.001) were significantly higher than in the control group. Satisfaction points in the intervention group with a mean of 12/75±16/76 was significantly higher than those of the control group with a mean of 7/51 ± 10/06 was (P=0.042).
Inquiry-based training, compared to the usual method, leads to an improvement in clinical skills and the satisfaction of nursing students. Hence, it seems that this educational method is effective and beneficent for teaching clinical reasoning and practical procedures.