Evidence Based Care
Volume:3 Issue: 3, 2013

Stroke is one of the major causes of disability. Therefore، it is important to introduce and develop new treatment approaches in order to improve and enhance post stroke recovery process for medical، social and economical purposes. To determine the effect of mirror therapy on motor ability of patients with stroke. This Randomized Controlled Trial was conducted on 38 patients with stroke، hospitalized in Imam Reza and Quaem hospital in Mashhad. They were randomly allocated into two groups of control (18 patients) and mirror therapy group (20 patients). In an experimental group، twenty 30minute sessions were performed daily or every other day. In this procedure، patients performed a range of motion of upper and lower extremities of healthy side in front of the mirror and observed only the mirror image. In additional to mirror therapy in both groups، the routine program (physiotherapy and neuromuscular stimulation) was performed. Upper and lower extremity motor abilities were assessed before، during and after the intervention using motor recovery scale، function index measure and function ambulation classification. Finally، data were analyzed by SPSS version 14. Two groups showed no significant difference in terms of motor ability indexes and confounding variables before the intervention. Motor ability indexes، movement recovery and walking ability in mirror therapy group were significantly improved in comparison with control group after the intervention. (P>0. 05) Mirror therapy can improve motor ability of patients with stroke as a simple، inexpensive and patient-oriented treatment.

Caring for family is essential for organ donation request and decision making process and nurses are responsible for family caring. the present study have performed to explore the role of quality of care and treatment in facilitating decision making and consent to organ donation in family of the brain death patient. A qualitative research approach with its focus on the content analysis was exploited. Participants were 26 brain-dead families who consented or refused from organ donation. Sampling method has started as purposive and continued as theoretical in transplantation center in Mashhad University of Medical Sciences in 2012. Accordingly، 38 unstructured interviews were conducted and data were analyzed using conventional content analysis. Data collection process included 38 unstructured in- depth interviews request. The analysis of the data leads to extraction of 610 initial codes and 13 categories and 4 themes including viewing the sufficiency of the care and treatment of the injured patients، empathic and effective communication، emotional support and giving assurance. From the abovementioned themes، “Motivational atmosphere of the decision-making” was extracted as the central theme. This study showed that health care and the team can play a significant role in brain dead family decision making and guiding it towards the consent or refuse to donate the organ. It is recommended that a specialized team consisting of doctors and nurses is formed this specialized training give them rely on caring of family in this complication situation (Communicational skills، support and mourning consulting).

Anxiety and depression are the most common complications after coronary artery bypass surgery. Although patients may gain some physical and psychological benefit from cardiac rehabilitation after cardiac surgery، but some individuals and social aspects may change the cardiac rehabilitation procedure. The aim of this study was to determine the effect of short-term cardiac rehabilitation on anxiety and depression in patients after coronary artery bypass surgery. In this quasi-experimental pretest – post test design study، all patients undergoing coronary artery bypass surgery in Razavi hospital in Mashhad (1392) were participated and for sampling، 70 patients allocated into experimental and control groups by non-randomly convenient method. Subjects in an experimental group received 4-week (10 sessions) cardiac rehabilitation program، while control group received only routine post discharge care. Data was collected using demographic form، social support questionnaire and the Hospital Anxiety and Depression Scale in both groups. Content validity method and Cronbach’s alpha reliability were used. Data were analyzed using statistical test Chi-square، Mann-Whitney، and independed t-test and paired t-test. Themean age of participants was 57. 3±8. 0 years old، which 70% of them were male. According to the t-test، before the intervention، there was no significant difference between two groups in anxiety and depression mean score، and two groups were equal in background and confounding variables. After the intervention، according to the t-test، mean score for anxiety in rehabilitation group (8. 8±3. 1) was significantly (P= 0. 031) lower than the control group (14±3. 9)، and mean score for depression in rehabilitation group (7. 8±2. 9) was significantly (P=0. 001) lower than the control group (14. 5±3. 2). Short-term cardiac rehabilitation program is effective in reducing anxiety and depression in patients after coronary artery bypass surgery. It may be used in care planning، patient education and encouragement for rehabilitation after cardiac surgery.

Preterm infants frequently experience oral feeding difficulties due to undeveloped oral- motor skills and lack of coordination between sucking، swallowing and breathing. Infants’ ability to orally consume all feedings while maintaining physiological stability and weight gain is necessary for their discharge. The effect of non-nutritive sucking on weight gain in preterm infants. A total of 40 preterm infants from the neonatal intensive care unit in Ghaem hospital in Mashhad were divided into experimental and control groups in this quasi-experimental study. The experimental group received non-nutritive sucking by mother before early feeding tube for 10 consecutive days. In the control group، feeding tube is started without sucking intervention. A chart review was then conducted to compare the access time to independent oral feeding and weight gain between the experimental and control groups. Data were analyzed by SPSS 16 software using Independent t and Mann Whitney tests. Characteristics of the two groups in terms of age، preterm birth، birth weight and sex were not significantly different. Average weight of non-nutritive sucking and control groups was 1384. 2±0. 203 and 1246. 1±193. 9 grams، respectively (p<0. 04). However، non-nutritive sucking had no effect on infant weight gain on the seventh، tenth، and fourteenth day of discharge. Non-nutritive sucking decreased significantly the length of stay (p<0. 02). Non-nutritive sucking has no significant effect on weight gain. Even non-nutritive sucking may cause infants’ energy expenditure and weight loss.

The diabetes mellitus is a disease with the disability to metabolize carbohydrates. The global prevalence of diabetes has estimated to be 439 million in 2030. Modification to the diet is an important factor in curing diabetes. Virtual learning is an important tool to guarantee the access of all patients to the dietary instructions. To determine the effect of E-learning education on dietary regimen in type 2 diabetic patients. This semi-experimental study was conducted on 85 patients suffering from diabetes type-2 admitted to ShahidQodsi health center in Mashhad. They were divided into two groups. Pre-and post-intervention questionnaire data and blood samples were recorded. The data were analyzed using SPSS Ver. 11. 5. The results showed that after the intervention، there was a significant increase in average value of adherence to the diet in group receiving virtual learning، compared to the group with face-to-face instructions (p<0. 05). The average and df were statistically significant in both groups in terms of glicosyled hemoglobin (p=0. 001). Considering the results of the present study، as virtual learning has a significant effect on adherence to the diet and several elements such as facilities، it is recommended for the nurses to get familiar with this type of learning method and instruct the patients in diabetes centers.

Thirst is the most common complaint of patients undergoing hemodialysis with stimulating the patient to drink more fluids result in intradialytic weight gain. Thirst leads to some complication including heart problem which is one of the most common causes of death in these patients. To determine the effect of ice chips on thirst and fluid intake of patients undergoing hemodialysis. This is a cross-over study consisting 49 patients. Patients were randomly divided into two groups of A and B. Both groups were trained on how to complete the check lists، measurement of liquids and fluid intake at intervals between sessions. Afterward، group A was trained about the use of alternating liquid and ice and registered in the check List and group B only about taking up the liquids and registered in the check List. In addition، the intervals between two dialysis sessions were reminded to patients by researcher by SMS for intervention and completion of the check List. Sixth week، intervention between two groups was moved. In all these sessions، intensity of thirst measured before and after and at the middle of each dialysis session. There was no significant differences between the use of ice chips with severity of thirst (p= 0. 806). Ice chips decreased fluid intake from 2375. 4±654. 2 to 2112. 9±656. 4 (p< 0. 001)، but frequency thirst increased from 12. 2±3. 7 to 16. 5±5. 4 (p< 0. 00). Ice chips had no effect on the intensity of thirst in patients undergoing hemodialysis despite increasing the frequency of thirst but result in reducing fluid intake.

The first year of life is the most important period of an extra uterine brain development requires environmental stimulation for developmental capabilities expression. Mean while، due to the repeated environmental disparity، nursery children are at great risk of developmental delay. To determine the effect of an evidence-based care package on infant gross motor development. In this randomized clinical trial، conducted at Ali Asghar (AS) nursery of Mashhad، an evidence-based care package was utilized. Fifty babies with the age of 12-1 months eligible according to inclusion criterion were randomly divided into the intervention (25 infant) and control (25 infant) groups. Then، the care package was administered for children in the intervention group، three times a week for 8 consecutive weeks (24 sessions، each two hours). Gross motor developmental age of the children was assessed by the Denver-II، before the intervention، 6 and 8 weeks after the intervention. The results were analyzed with SPSS 11. 5 software using independent t-test، Mann-Whitney U and repeated measures ANOVA. The mean age of the sample was 20. 64 ± 14. 62 years and 32% of total were female and 68% male. The average of the gross motor age were 21. 4±7. 9 and 15. 8±13. 0 years in the intervention and control groups (P>0. 05)، respectively. After 6 weeks implementation of the care package، the difference of the mean of the gross motor age between the intervention (26. 5±10. 8) and control groups (21. 4±11. 4) was not statistically significant (P=0. 115). Two weeks later (8th weeks)، the difference of the mean of the gross motor age in the intervention group (29. 4±10. 5) and control group (22. 9±10. 3) was statistically significant (P=0. 033). Six weeks intervention by this evidence-based care package is not effective on the infant''s gross motor development. This effect was determined after 8 weeks of an intervention. This package can be used to improve gross motor skills in infants at risk of developmental delay such as infant sliving inorphanages.

Evidence-based care guidelines are one of the new ways to improve the quality of care and increase patient satisfaction. In addition to the mental and emotional problems، mentally ill patient suffers from multiple health problems. The most common patient''s bio-psycho problems are insomnia and constipation. The aim of this study was to designing and Accredit the evidence-based care guidelines on insomnia، and constipation in psychiatric patients. This study is a developmental research and was performed in mental wards of the Baqiyatallah hospital in Tehran in 1392. Evidence-based care guidelines were designed based on the stetler model in evidence-based approach. To check the validity of the content instruction with Delphi method، comments of ten elected faculty members were considered in three different stages. Application of the guidelines was examined using ten experts in focused group discussions. In addition to nursing books، 100 articles from proquest، Pubmed، Google scholar، Elsevier، SID، and Magiran with evidence based nursing care، insomnia، constipation، psychiatric patients، protocol keywords were studied. In this study، 4 evidence-based care guidelines، including nursing diagnosis، etiology، evaluation criteria، and nursing interventions were designed. These guidelines can be used as a clinical guide for the care of psychiatric patients based on the credible scientific literature and evidence-based approach. With designing evidence-based nursing care instructions for psychiatric patients، the need of clinical nurses in confronting these patients was removed. It also leads to improve the quality of care and reduce complications in duration of the hospital stay.