habibollah hosseini

Colorectal cancer (CRC) is one of the most common and age-related cancers worldwide.

The present study aimed to determine the recurrence, severity, distress, and clustering of symptoms in the elderly with colorectal cancer in the selected hospitals in Isfahan from 2018 to 2019.

This descriptive-analytical study was conducted over a period of six months on 300 patients with colorectal cancer in selected hospitals in Isfahan. Data collection tools were contextual questionnaires and symptom recall scale (MSAS). To determine the correlation matrix between symptoms (clusters), a heuristic analysis factor was used in terms of mean recurrence, severity, and distress of symptoms in research units through PCA heuristic analytical method in SPSS 16.

The most common symptoms in terms of recurrence were dry mouth (32.92%) and numbness and frisson (24.55%). The most common symptoms in terms of recurrence were dry mouth (80.33%) and nausea (86%); the most common symptoms in terms of severity were dry mouth (41%) and nausea (29.8%). The most common signs of distress were "I do not look like myself" (6) and dry mouth (35.3%). Finally, five clusters were obtained, including systemic, psychiatric, cardiovascular, mucosal, and gastrointestinal symptoms.

The results of the present study showed that psychological symptoms had a higher percentage of recurrence, severity, and distress in CRC patients than physical symptoms.

Post-operative pain reduction is one of the problems in the patients with preoperative narcotic dependency. Morphine is the most common drugs to control postoperative pain. Due to resistance to morphine and its side effects in addict patients, using of adjuvant drugs such as ketamine has increased. The aim of this study was to evaluate the effect of adding ketamine to morphine in patients addicted to opioid with post orthopedic operation pain.
In a double blind clinical trial, 60 patients undergoing orthopedic operation with history of opioid consumption were randomly divided in 2 groups. Post operation, the first group received morphine 20 mg and the second group received morphine 20 mg ketamine 100 mg via IV patient-controlled analgesia (IPCA). The pain score as visual analogue scale (VAS), sedation score, and nausea and vomiting were evaluated at 1, 6, 12 and 24 hours post operation. SPSS v.20 was used for data analysis.
Results showed that dose of morphine consumption in morphine group was significantly increased compared to the morphine ketamine group (p 0.001). In addition, only at 12 hours after surgery the mean of pain score in the morphine group was significantly reduced compared to the second group (p = 0.02). The mean of sedation score at 1 (p 0.001), 6 (p = 0.002), 12 (p = 0.001) and 24 (p 0.001) hours after surgery in the morphine group was increased compared to the other group. At 1 hour, the mean of nausea and vomiting scores in the morphine group was significantly reduced compared to the morphine ketamine group (p = 0.024).
Addition of ketamine to morphine in the patients with history of opioid consumption reduced using of the morphine. But had no effect on pain and sedation score reduction.

The prevalence of chronic diseases, such as diabetes mellitus, in elderly can be controlled with training self-control behaviors, especially in peer groups. Regarding to specific conditions and greater rate of complications in the elderly, the peer group self-care education is in specific importance among these patients. The present study was aimed to investigate the effect of peer group training on the self-care of elderly with diabetes in selected health centers of Isfahan.
The present clinical trial compared 21 elderly patients with diabetes higher than 65 years old trained by a peer educator and 23 elderly patients received training by none peer group (trained by a researcher) for 4 months. The samples were randomly divided into two groups. The self-care behaviors were assessed by a questionnaire in 4 dimensions of diet, sport, glucose test, and diabetic drugs and the results were compared between groups. T-independent for statistical tests and to compare three times in a group was used ANOVA with repeated observations.
The total score of self-care in the test group increased significantly from 31±5.61 before intervention, to 42±7.01 after intervention and 35.55±5.11 one month after intervention, while the control group had no significant change. Different dimensions of the questionnaire were not statistically with a significant difference between groups, except in the field of sports was significant a month later intervention (P=0.05). There was a direct relationship between level of education and self-care score.
According to the findings, training the elderly patients with diabetes by a peer group can promote their self-care. Therefore, training with a peer group is advised as an efficient method for improving self-care of elderly diabetic patients.

Nowadays with respect to the automation of the lifestyle, immobility statistics in middle‑aged women has increased and they are at risk for complications of immobility. One of the models used to identify factors associated with physical activity is Health Belief Model utilized in different age and different cultural backgrounds and different results have been obtained from those studies. The purpose of this study was to investigate the factors affecting on physical activity in middle‑aged women using Health Belief Model.

This descriptive‑correlation study was conducted on 224 middle‑aged women referring to health centers in Isfahan. Health Belief Model structures including perceived susceptibility and severity, perceived barriers and benefits, and self‑efficacy were measured by questionnaire and physical activity was assessed using the international physical activity questionnaire. Collected data were analyzed using descriptive statistics and Pearson correlation coefficient test and regression analysis.

There wasn’t significant correlation between perceived susceptibility (P = 0.263, r = 0.075) and perceived severity with physical activity duration (P = 0.127, r = 0.058) but there was positive and weak correlation between physical activity duration with perceived benefits (P = 0.001 and r = 0.26) and perceived self‑efficacy (P = 0.001, r = 0.54) and had weak and inverse correlation with perceived barriers (P = 0.001, r = ‑0.25). Regression analysis also showed that from among all the Health Belief Model structures just self‑efficacy structure has influenced on behavior independently and other structures are affected by it.

The obtained results implied on a correlation between benefits, barriers and perceived self‑efficacy with and moderate physical activity. Therefore it is necessary to develop appropriate educational programs with emphasis on structures of Health Belief Model that has the maximum impact on physical activity in middle‑aged women.

Various factors threaten the health and recovery of hospitalized elderly, including stressors in medical service centers. Therefore, the aim of the present study was to develop and preliminary validate a measurement tool to assess hospitalization-related stressors (HRS) among the elderly.
This methodological research was conducted in 2015. The study was performed in two main phases. In the first phase, which was to develop the questionnaire, the data were collected through literature review, interview with few elderly patients, and calculating content validity index with the participation of 16 experts. The second phase included preliminary validation of the questionnaire in which a convenient sample of 200 hospitalized elderly patients recruited from 4 educational medical centers of the Isfahan University of Medical Sciences were studied. Principal component analysis method was used to identify the factorial structure of the questionnaire. In order to evaluate validity, Cronbach’s alpha coefficient was calculated.
After evaluating the results and relocating and merging some of the items, a version of 26 items in 7 categories was prepared with acceptable internal consistency (Cronbach’s alpha coefficient from 0.67 to 0.78 for the components and 0.83 for the tool).
In this study, we were able to identify a set of important components and indicators of HRS in elderly; so it can be used as a useful instrument. Future studies are recommended in order to develop and validate this tool in other communities.

The ischemic preconditioning phenomenon can save myocardium against move severe ischemic damages and reduce infarction size and furthermore a heart rhythm disturbance. In this study we examine relationship between troponin I (as a structural myocardial protein) level and anesthetic agents in the children.

In this study 84 children under 12 years age before cardiac surgery were divided randomly into two groups of 42 each. For anesthetic maintenance sevoflurane with dose of 0.5-1 MAC was used in Group 1 and 100-150 mg/kg/min of intravenous propofol in Group 2 for maintenance of anesthesia. Troponin I level was assessed 2 before and 1 hour after anesthetic induction. Outcome measures included the serum cardiac troponin I level in children before and after surgery in two study groups.

There was no significant difference between two groups in indices and both groups were homogenous in this point of view. The troponin I level after surgery was significantly increased in two groups. In the sevoflurane group it was 0.04 ± 0.12 to 0.05 ± 0.09 ng/ml (P value = 0.003) and the propofol group was 0.12 ± 0.26 to 0.19 ± 0.38 ng/ml (P value = 0.001).

In this study two Anesthetic regimens were compared to assess the mean troponin I level before and after pediatric closed heart surgery, and it was shown that mean troponin level before and after surgery in the sevoflurane group was less than the propofol group. But this result was not statistically significant. These results indicate that although more protective effects of sevoflurane on myocardial injuries during pediatric cardiac surgery is predominant but this effect has no significant difference in the propofol group.

One of the most important roles intended for nurses is their educational role in the community. Accordingly، this study was implemented to review the results of this role and to determine the effect of education on HCV+ patients’ knowledge of Hepatitis C in MMT and DIC centers and other healthcare networks of Isfahan Province. This quasi-experimental study was performed in year 2011 on HCV+ patients covered by MMT and DIC and healthcare networks of Isfahan province. Ninety seven HCV+ patients were trained by superintendents on various aspects of Hepatitis C including transmission، prevention، complications and etc. via workshops. Knowledge was assessed before and after training. Required information was collected by a questionnaire designed for this purpose and was analyzed using descriptive statistical tests، Chi2، student t and paired t test. Mean scores of patients’ knowledge before and after intervention were 11. 9±5. 3 and 18±3. 13 respectively. Paired t test showed that the difference in patients’ knowledge mean scores before and after intervention was significant (p<0. 001). According to the results، providing information on this disease leads to improvement of individuals’ knowledge and attitude. This can influence the controlling process of Hepatitis C in the community especially in relation to transmission to other people

Perceived self‑efficacy is a strong predictor for behavior. Considering the importance of health‑promoting self‑care behaviors in increasing quality of life in the elderly, this study was aimed at defining the effect of nurse home visits on self‑care self‑efficacy of the elderly in rural areas. This is a pre and post quasi‑experimental study conducted on 33 older adults randomly selected from five villages in Falavarjan province in Iran. Intervention program was in the direction of self‑care self‑efficacy in four domains including nutrition, health practice, physical activity, and well‑being in the form of five home visit programs and one group session by a nurse during 6 weeks, and included two different sections of education and nursing interventions administered based on needs assessment and determination of the tasks for the clients and their families. Theoretical framework of this study was supported by Bandura’s self‑efficacy, Orem’s self‑care theory, and Pender’s revised health promotion model. The data were collected by self‑care self‑efficacy and demographic information questionnaire before and after the intervention. Data were analyzed by descriptive statistics and paired t‑test. The mean elderly score in the four aforementioned domains increased after the home visit program. A significant difference was seen in the mean total scores of self‑care self‑efficacy and its subscales by paired t‑test before and after intervention (P < 0.001). It was observed that home visit program, integrated with the theories, had a positive influence on improving self‑care self‑efficacy of the elderly, and was supported by Bandura’s theory of self‑efficacy suggesting four sources of performance accomplishment, vicarious experience, verbal persuasion, and emotional arousal. With regard to the importance of self‑care behavior in health promotion of the elderly, multifaceted low‑cost interventions with the highest effect seem essential.

Irregular population growth is considered as a serious threat to the international community. It is also a major obstacle against nation's social and economic development. Thus, one of the ways to control the population is providing effective contraceptive methods. Vasectomy is one of the most effective, simple contraceptive methods confirmed by the World Health Organization. It is important to involve men in population control and reproductive health promotion. Therefore, this study aimed to describe the experiences of a group of vasectomized men.

This qualitative study was conducted using a phenomenological approach. Subjects were 14 vasectomized men selected through purposive sampling. In-depth and open interviews with participants were conducted to collect data. Observations were also recorded in comprehensive field notes. A Colaizzi method was used to analyze the data transcripts.

Four themes were driven from the obtained results which describe the structures of vasectomy-related experiences among men. These themes included opinions about vasectomy, impressions about vasectomy, vasectomy experiences, and recommendation to others.

Recognizing experiences of vasectomized men and determining positive and negative aspects of this method would make specialists able to design effective vasectomy promotion training programs.

General concept and major emphasis on off-pump coronary artery bypass surgery (OPCAB) is maintaining quality of care and patient safety while reducing cost and resource utilization. OPCAB probably avoids the potential complications of cardiopulmonary bypass. However its acceptance depends on clinical and economic outcome. The aim of this study is to compare clinical and economic outcome of off-pump and on pump coronary artery bypass surgery. This is a report of an analytic cross-sectional study on 304 patients underwent coronary artery bypass surgery that were randomized into conventional on pump and off-pump groups. Variables and costs were obtained for each group and these data were analyzed using parametric methods. There was no difference between the two groups with respect to perioperative and intraoperative patient's variables. OPCAB reduced the need for postoperative transfusion requirement (P<0.05) which was statistically significant and showed a trend towards reduction of morbidity although didnt reach statistical significance (P>0.05). There were no statistically significant differences in surgical re exploration and length of stay between the two groups. The mean cost for an on pump surgery was 8312000 ± 2859 Rials per patient that was significantly higher than an off-pump surgery. Based on the findings of this study, clinical outcome has no statistically significant difference between on pump and off-pump CABG but the costs are significantly higher in the on pump group.

The duration of ICU (intensive care unit) stay in cardiac surgery patients has an important role in the rate of complications and costs. The aim of this study was to determine the role of perioperative risk factors in clinical outcome based on the time of ICU discharge. In this descriptive study, 219 patients undergoing off-pump coronary artery bypass (OPCAB) surgery in Afshar Hospital in Yazd, an Iranian city, were divided into early (≤24 hrs) and late (>24 hrs) ICU discharge groups according to the duration of ICU stay. The preoperative, intraoperative and postoperative risk factors, the complications and the outcome were evaluated. Age, sex, hyperlipidemia, diabetes mellitus, previous myocardial infarction, renal failure, cerebrovascular accident, and level of hematocrit and creatinine were not significantly different between the two groups. Patients with hemodynamic instability, respiratory dysfunction, ejection fraction <35%, hypertension, inotrope administration, left main coronary artery involvement, use of intraaortic balloon pump (IABP) and arrhythmia had significantly higher mortality and longer ICU stay (>24 hrs) compared to others (P value <0.05). The duration of intubation was significantly lower in the early discharge group (7.8 ± 3.8 hrs compared to 17 ± 9.9 hrs) than in the late discharge group. Time of ICU discharge depends on perioperative risk factors, and risk factor modification may improve clinical outcome.

The population growth is an important issue affecting all dimensions of human life. Men play an important role in family planning. The present study aims to investigate men cooperation in family planning after a group training program of their spouses. This study was a quasi-experimental research. In this study the effect of a group training on contraception on 53 women who used natural method of contraception was measured on their husbands. Before and after intervention an awareness and practice questionnaire about contraception methods was completed in studied women and their husbands. Data analysis was done by SPSS software and descriptive and analytic statistical tests. A significant difference was found between the awareness scores of the intervention group and their spouses before and after the group training (P < 0.001). 51 percent of the studied women and their husbands underwent an effective contraception method after group trainings The results of the study indicated that women group training can increase men cooperation in family planning programs.

Sleep disturbances are common among older adults. Recently there is much interest in complementary and alternative medicine (CAM) from the population in general, and the elderly are no exception. Tai Chi exercise as a CAM can be performed by older adults. The purpose of this study was to evaluate the effects of Tai Chi Exercise on sleep quality of elderly residents in Sadeghiyeh elderly care home. In this Clinical Trial, 62 older subjects aged older than 65 years residents of elderly home in Isfahan were studied. They randomized in two experimental and control groups. The intervention was the Tai Chi Exercise sessions wereheld three times per week for 12 weeks. Duration of exercise was 5 minutes at first session which gradually increased to 20 to 25 minutes by the midpoint of intervention. The Pittsburgh Sleep Quality Index (PSQI) was used for pre and post evaluation of older adult sleep quality. Data analyzed using the SPSS14 software. There were no differences in demographic characteristics or psychological variables between two groups. Mean age of studied subjects in experimental and control groups was 68.74(5.48) and 69.42(5.34), respectively. In the Tai Chi group sleep quality was improved significantly with decrease in PSQI global score. In control group sleep quality was not changed significantly. At the end of study, mean differences of PSQI global score between two groups different significantly. Our finding is coherent with other studies in this field indicated that the Tai Chi Exercise can have a significant effect on sleep quality in older adults.

Mycotic pseudoaneurysm of the ascending aorta is rare in patients undergoing coronary artery bypass graft (CABG) and usually caused by staphylococcus aureus. We describe a patient with a mycotic pseudoaneurysm of the ascending aorta at the proximal vein graft anastomosis site after CABG. Culture from the sinus tract of the sternum and from the aneurysm sac was Klebsiella pneumoniae. Surgical technique was patch repair of aorta under hypothermic circulatory arrest. He is asymptomatic at 24 months follow-up.

Interpersonal communication is considered as an important and effective factor of job satisfaction and efficiency and has special significance in nursing career because of face to face relationship with patients. This study aimed to determine the association between head nurses'' interpersonal communication and job satisfaction of nurses under their supervision. The study was conducted in educational hospitals of Isfahan University of Medical Sciences in 2006. This is a descriptive and analytical study on 203 nursing personnel working in educational hospitals of Isfahan University of Medical Sciences in 2006. Data were collected using Job Descriptive Index (JDI) developed by Smith and Kendall and interpersonal communication was measured using a researcher-made questionnaire. Data were analyzed using SPSS software and Pearson''s test and presented in tables and diagrams. Majority of the participants (148 subjects, 73%) believed that head nurses'' interpersonal communication was excellent and in general Pearson''s test showed a significant association between head nurses'' interpersonal communication and their personnel''s job satisfaction (p < 0.011). Based on the results of this study on the relationship between interpersonal communication of the head nurses and job satisfaction of their personnel, we can improve the job satisfaction of nursing personnel as well as patients'' satisfactory and level of services by developing educational courses and workshops on importance and effectiveness of interpersonal communication for head nurses.

Aortobronchial fistula (ABF) is a rare and late complication of cardiac surgery. If untreated, mortality rate is approximately 100% secondary to exsanguinations haemoptysis. Early diagnosis and treatment are essential for successful management. Open surgical repair is associated with high morbidity and mortality rate, ranging from 25% to 41%. Endovascular treatments of ABF is a less invasive treatment modality and have become an important alternative to open surgical intervention in aortic pathologies. We present a case of ABF that successfully is managed by endovascular approach.

onset tracheotomy complication: A Case report Tracheo-innominate artery fistula (TIF) is a rare, life threatening and catastrophic complication, which may occur 7 to 14 days after surgery. The Incidence Rate of TIF is 0.1-1% and survival rate of patient is 14.3%. Herein, we describe TIF in a patient 50 days post tracheotomy, based on our research, it appears that our case is the first finding with the latest onset of TIF after tracheotomy, which now has been improved by early diagnosis and surgical treatment.

Physical growth is influenced by different factors including genetics, environment and nutrition. This study aimed to recognize the factors may affect children''s growth at the beginning of supplementary diet. This longitudinal-analytical study surveyed 75 randomly selected babies less than 8 month of age under the supervision of Felaverjan Health Center and their mothers in 2005. The data were collected by a questionnaire composed of three sections; babies'' demographic and caring characteristics, mothers'' demographic characteristics, and babies'' weight in 5th and 7th months of age as well as some questions about mothers'' takeing care of their babies. Data were analyzed using descriptive statistics and Mann-Whitney, Wilcoxon, and Pearson correlation coefficient tests in SPSS software. 36% of the babies were girls and 64% were boys. 52% of babies were the first child. The mean birth weight was 3021.6 ± 046.7 g. The mean age of mothers was 25.5 ± 6.3 years; 65.3% of mothers had primary school education and about 50% were economically well-off. However, the results showed no significant relation between mothers'' demographic characteristics and babies'' growth pattern. It was a significant direct relation between growth pattern and the weight of babies at the time of supplementary diet (p = 0.03) and birth weight (p = 0.001). Also It was a significant relation between growth pattern and mothers'' care of babies (p = 0.048). Elements of birth weight, weight before and after supplementary diet, and mothers'' care of babies are important factors in the babies'' growth after taking supplements.

As the nurses working in emergency ward are the first group who make early interventions to save critical patients, this is considered as a need for them to get enough knowledge and skills in this field. On the other hand, standards show nurses to the appropriate level of care quality (the meaning of sentence is not clear). Ignoring structural and process standards can result in personnel dysfunction and their low nursing services. This study has tried to define the mean obedience of structural and process standards such as physical environment, facilities and manpower as well as process standards like patient care in an emergency ward of a selected hospital of Isfahan university of medical science. This was a descriptive cross-sectional study carried out in a selected hospital of Isfahan university of medical science. First, a checklist for physical environment, facilities and manpower was designed and the data were collected from the emergency ward personnel (nurses and nurse aids) working in the ward through direct and indirect methods. Then, the collected data were analyzed by descriptive statistics after being classified. The findings of the study showed the ward had obedience level of 83.8% for physical environment, 75% for facilities and equipments and 64.5% for manpower. About 46% of the personnel had excellent efficacy and 32.9% had low to moderate efficacy. According to the results, we have good manpower programs; efficient records control tools and adequate facilities. Meanwhile, strategies of motivation and job satisfaction enhancement which need a board attitude should not be ignored but considered as well. KEY WORDS: Processes Standard, structure standard, nursing care standard