Toward Integration of Pharmacogenomic Tests into Daily Clinical Practice: A General Survey for Polish Healthcare Workers.

BACKGROUND Pharmacogenomics (PGx) has a direct influence on personalized drug therapy for various types of disorders and has been proven to have an important role in the future of medicine. The present study evaluated the awareness of PGx testing of clinicians and healthcare workers in the Republic of Poland. To the best of our knowledge, this is the first direct assessment of Polish healthcare professionals' attitudes toward introducing PGx tests into daily clinical practice. MATERIAL AND METHODS We used a comprehensive anonymous questionnaire with queries on level of education, background knowledge of PGx tests, advantages and barriers for implementation of such tests, and clinicians' desire to order the test that was distributed online to doctors, healthcare workers, related students/Ph.D. students, and administrative staff managing healthcare units. RESULTS We gathered 315 responses. According to the answers, two-thirds of participants had heard about PGx before (64.4%). An overwhelming majority of respondents appreciated the benefits of PGx (93.3%). Indeed, prior knowledge and level of education showed significant associations with positive attitudes toward PGx clinical testing (P≤0.05). However, all participants agreed there are major challenges for including such tests as part of routine clinical practice. CONCLUSIONS While the awareness and interest in PGx clinical testing in Polish healthcare providers are rising, some main barriers for implementation of these tests still need to be addressed in Poland.

Comparison of decision tree with common machine learning models for prediction of biguanide and sulfonylurea poisoning in the United States: an analysis of the National Poison Data System.

BACKGROUND: Biguanides and sulfonylurea are two classes of anti-diabetic medications that have commonly been prescribed all around the world. Diagnosis of biguanide and sulfonylurea exposures is based on history taking and physical examination; thus, physicians might misdiagnose these two different clinical settings. We aimed to conduct a study to develop a model based on decision tree analysis to help physicians better diagnose these poisoning cases. METHODS: The National Poison Data System was used for this six-year retrospective cohort study.The decision tree model, common machine learning models multi layers perceptron, stochastic gradient descent (SGD), Adaboosting classiefier, linear support vector machine and ensembling methods including bagging, voting and stacking methods were used. The confusion matrix, precision, recall, specificity, f1-score, and accuracy were reported to evaluate the model's performance. RESULTS: Of 6183 participants, 3336 patients (54.0%) were identified as biguanides exposures, and the remaining were those with sulfonylureas exposures. The decision tree model showed that the most important clinical findings defining biguanide and sulfonylurea exposures were hypoglycemia, abdominal pain, acidosis, diaphoresis, tremor, vomiting, diarrhea, age, and reasons for exposure. The specificity, precision, recall, f1-score, and accuracy of all models were greater than 86%, 89%, 88%, and 88%, respectively. The lowest values belong to SGD model. The decision tree model has a sensitivity (recall) of 93.3%, specificity of 92.8%, precision of 93.4%, f1_score of 93.3%, and accuracy of 93.3%. CONCLUSION: Our results indicated that machine learning methods including decision tree and ensembling methods provide a precise prediction model to diagnose biguanides and sulfonylureas exposure.

The value of machine learning for prognosis prediction of diphenhydramine exposure: National analysis of 50,000 patients in the United States.

Background: Diphenhydramine (DPH) is an antihistamine medication that in overdose can result in anticholinergic symptoms and serious complications, including arrhythmia and coma. We aimed to compare the value of various machine learning (ML) models, including light gradient boosting machine (LGBM), logistic regression (LR), and random forest (RF), in the outcome prediction of DPH poisoning. Materials and Methods: We used the National Poison Data System database and included all of the human exposures of DPH from January 01, 2017 to December 31, 2017, and excluded those cases with missing information, duplicated cases, and those who reported co-ingestion. Data were split into training and test datasets, and three ML models were compared. We developed confusion matrices for each, and standard performance metrics were calculated. Results: Our study population included 53,761 patients with DPH exposure. The most common reasons for exposure, outcome, chronicity of exposure, and formulation were captured. Our results showed that the average precision-recall area under the curve (AUC) of 0.84. LGBM and RF had the highest performance (average AUC of 0.91), followed by LR (average AUC of 0.90). The specificity of the models was 87.0% in the testing groups. The precision of models was 75.0%. Recall (sensitivity) of models ranged between 73% and 75% with an F1 score of 75.0%. The overall accuracy of LGBM, LR, and RF models in the test dataset was 74.8%, 74.0%, and 75.1%, respectively. In total, just 1.1% of patients (mostly those with major outcomes) received physostigmine. Conclusion: Our study demonstrates the application of ML in the prediction of DPH poisoning.

Which model is superior in predicting ICU survival: artificial intelligence versus conventional approaches.

BACKGROUND: A disease severity classification system is widely used to predict the survival of patients admitted to the intensive care unit with different diagnoses. In the present study, conventional severity classification systems were compared with artificial intelligence predictive models (Artificial Neural Network and Decision Tree) in terms of the prediction of the survival rate of the patients admitted to the intensive care unit. METHODS: This retrospective cohort study was performed on the data of the patients admitted to the ICU of Ghaemshahr's Razi Teaching Care Center from March 20th, 2017, to September 22nd, 2019. The required data for calculating conventional severity classification models (SOFA, SAPS II, APACHE II, and APACHE IV) were collected from the patients' medical records. Subsequently, the score of each model was calculated. Artificial intelligence predictive models (Artificial Neural Network and Decision Tree) were developed in the next step. Lastly, the performance of each model in predicting the survival of the patients admitted to the intensive care unit was evaluated using the criteria of sensitivity, specificity, accuracy, F-measure, and area under the ROC curve. Also, each model was validated externally. The R program, version 4.1, was used to create the artificial intelligence models, and SPSS Statistics Software, version 21, was utilized to perform statistical analysis. RESULTS: The area under the ROC curve of SOFA, SAPS II, APACHE II, APACHE IV, multilayer perceptron artificial neural network, and CART decision tree were 76.0, 77.1, 80.3, 78.5, 84.1, and 80.0, respectively. CONCLUSION: The results showed that although the APACHE II model had better results than other conventional models in predicting the survival rate of the patients admitted to the intensive care unit, the other conventional models provided acceptable results too. Moreover, the findings showed that the artificial neural network model had the best performance among all the studied models, indicating the discrimination power of this model in predicting patient survival compared to the other models.

Risk assessment of elevated blood lead concentrations in the adult population using a decision tree approach.

Lead is a common toxin which has detrimental effects on human health. Since lead poisoning is not associated with specific symptoms, diagnosing elevated blood lead concentration (EBLC) should be taken seriously. The purpose of this study was to propose a prediction model for EBLC based on demographic and clinical variables through a decision-tree model.In this cross-sectional study, 630 subjects (above 40 years old) living in South Khorasan Province, Iran in 2017 were selected via cluster random sampling method. From among the 630 participants who met the inclusion criteria, 70% (N = 456) were chosen randomly to achieve a set for developing the decision tree and multiple logistic regression (MLR). The other 30% (N = 174) were placed in a holdout sample to examine the function of the decision tree and MLR models. The predictive performance for various models was studied using the Receiver Operating Characteristic (ROC) curve.In the decision tree model, the parameters of hematocrit (HCT), White Blood Cell (WBC), Red Blood Cell (RBC), Mean corpuscular volume (MCV), creatinine concentration, abdominal pain, gender, route of administration, and history of cigarette smoking were the most critical factors in identifying people at risk of EBLC. The HCT concentration was the most critical variable, which was chosen as the root node of the tree. Based on the ROC curve, the decision tree model had better predictive accuracy than the logistic regression model.Our results indicated that the decision tree model offers far greater predictive precision than the logistic regression model. Doctors should pay more attention to some factors including the hematological parameters such as MCV, RBC, HCT, leukocytosis, creatinine levels, male sex, history of cigarette, and opium consumption for the screening of EBLCs.

Trends of acute drug and chemical toxicities in adults and adolescents in Tehran, Iran between 2012 and 2018: a retrospective chart review.

Poisoning is among the top three common causes of suicidal deaths in Iran. We aimed to evaluate the epidemiologic trend of poisoning and its mortality rate in the largest tertiary toxicology referral center in Iran between 2012 and 2018. A total of 84,242 patients were hospitalized or died due to poisoning in this center during the study period, of whom 2114 (2.5%) died. The most frequent poisonings were those with antiepileptics, sedativehypnotics, and antiparkinson medications (T42) followed by narcotics and psychodysleptics (T40). Psychodysleptics had the highest mortality rate (684; 32.4% of the deaths). Among drugs of abuse, methadone was the most common cause of admission reported in 10,398 cases (12.3%). In conclusion, suicidal or recreational methadone poisoning is becoming the most common cause of admission to poisoning referral wards in Iran. Rigorous supervision of daily dosing at opioid maintenance clinics as well as efforts to control the black-market offering methadone are needed to prevent further methadone-related acute poisonings and deaths.

The effects of naloxone, diazepam, and quercetin on seizure and sedation in acute on chronic tramadol administration: an experimental study.

BACKGROUND: Tramadol is a widely used synthetic opioid. Substantial research has previously focused on the neurological effects of this drug, while the efficacy of various treatments to reduce the associated side effects has not been well studied. This study aimed to evaluate the protective effects of naloxone, diazepam, and quercetin on tramadol overdose-induced seizure and sedation level in male rats. METHODS: The project was performed with 72 male Wistar rats with an average weight of 200-250 g. The rats were randomly assigned to eight groups. Tramadol was administered intraperitoneally at an initial dose of 25 mg/kg/day. On the 14th day, tramadol was injected at 75 mg/kg, either alone or together with naloxone, diazepam, and quercetin (acute and chronic) individually or in combination. The rats were monitored for 6 h on the last day, and the number, the duration, and the severity of seizures (using the criteria of Racine) were measured over a 6-h observation period. The sedation level was also assessed based on a 4-point criterion, ranging from 0 to 3. Data were analyzed in SPSS software using Kruskal-Wallis, Chi-square, regression analysis, and generalized estimating equation (GEE) tests. The significance level was set at P < 0.05. RESULTS: The naloxone-diazepam combination reduced the number, severity, and cumulative duration of seizures compared to tramadol use alone and reduced the number of higher-intensity seizures (level 3, 4) to a greater extent than other treatments. Naloxone alone reduced the number and duration of seizures but increased the number of mild seizures (level 2). Diazepam decreased the severity and duration of seizures. However, it increased the number of mild seizures (level 2). In comparison with the tramadol alone group, the acute quercetin group exhibited higher numbers of mild (level 2) and moderate (level 3) seizures. Chronic quercetin administration significantly increased the number of mild seizures. In the GEE model, all groups had higher sedation levels than the saline only group (P < 0.001). None of the protocols had a significant effect on sedation levels compared to the tramadol group. CONCLUSION: The combined administration of naloxone and diazepam in acute-on-chronic tramadol poisoning can effectively reduce most seizure variables compared to tramadol use alone. However, none of the treatments improved sedation levels.

COVID-19 pandemic and methanol poisoning outbreak in Iranian children and adolescents: A data linkage study.

BACKGROUND: During the first wave of COVID-19, many Iranians were poisoned by ingesting hand sanitizers and/or alcoholic beverages to avoid viral infection. To assess whether the COVID-19 pandemic resulted in an increased prevalence of accidental hand sanitizer/alcoholic beverage exposure in children and adolescents, we compared pediatric hospitalization rates during COVID-19 and the previous year. For poisoning admissions during COVID-19, we also evaluated the cause by age and clinical outcomes. METHODS: This retrospective data linkage study evaluated data from the Legal Medicine Organization (reporting mortalities) and hospitalization data from nine toxicology referral centers for alcohol-poisoned patients (age 0 to 18 years) for the study period (February 23 to June 22, 2020) and the pre-COVID-19 reference period (same dates in 2019). RESULTS: Hospitalization rates due to ethanol and methanol exposure were significantly higher in 2020 (n = 375) than 2019 (n = 202; OR [95% CI] 1.9 [1.6, 2.2], p < 0.001). During COVID-19, in patients ≤15 years, the odds of intoxication from hand sanitizers were significantly higher than from alcoholic beverages, while in 15- to 18-year-olds, alcoholic beverage exposure was 6.7 times more common (95% CI 2.8, 16.1, p < 0.001). Of 375 children/adolescents hospitalized for alcoholic beverage and hand sanitizer exposure in 2020, six did not survive. The odds of fatal outcome were seven times higher in 15- to 18-year-olds (OR (95% CI) 7.0 (2.4, 20.1); p < 0.001). CONCLUSION: The Iranian methanol poisoning outbreak during the first wave of COVID-19 was associated with significantly increased hospitalization rates among children and adolescents-including at least six pediatric in-hospital deaths from poisoning. Public awareness needs to be raised of the risks associated with ingesting alcoholic hand sanitizers.

Effects of naloxone and diazepam on blood glucose levels in tramadol overdose using generalized estimating equation (GEE) model; (an experimental study).

BACKGROUND: Tramadol is a synthetic opioid and poisoning is increasing around the world day by day. Various treatments are applied for tramadol poisoning. Due to the unknown effects of tramadol poisoning and some of its treatments on blood glucose levels, this study was conducted to investigate the overdose of tramadol and its common treatments (naloxone, diazepam), and their combination on blood glucose levels in male rats. METHODS: This study was conducted in 45 male Wistar rats. The animals were randomly divided into five groups of 9. They received a 75 mg/kg dose of tramadol alone with naloxone, diazepam, and a combination of both of these two drugs. On the last day, animals' tail vein blood glucose levels (BGL) were measured using a glucometer at different times, including before the tramadol injection (baseline) and 1 hour, 3 hours, and 6 hours after wards. The rats were anesthetized and sacrificed 24 h after the last injection. Blood samples were then taken, and the serum obtained was used to verify the fasting glucose concentration. Data were analyzed using SPSS software at a significance level of 0.05 using a one-way analysis of variance (ANOVA) and a generalized estimating equation (GEE). RESULTS: According to the GEE model results, the diazepam-tramadol and naloxone-diazepam-tramadol groups showed blood glucose levels five units higher than the tramadol group (p < 0.05). The diazepam-tramadol group had significantly higher blood glucose levels than the naloxone-tramadol group (p < 0.05). The mean blood glucose levels before the intervention, 3 hours and 6 hours after the injection of tramadol did not differ between the groups, but the blood glucose levels 1 hour after the injection of tramadol in the group of naloxone-tramadol were significantly lower than in the control group (p < 0.05). Blood glucose levels did not differ between the groups 24 h after injection of tramadol. CONCLUSION: The results of the present study showed tramadol overdose does not affect blood glucose levels. The diazepam-tramadol combination and the diazepam-naloxone-tramadol combination caused an increase in blood glucose levels.

Opium use and cardiovascular diseases: a systematic review and meta-analysis.

The effects of opium on cardiovascular diseases (CVDs) have been extensively studied. However, there are few studies that summarize this research comprehensively; thus, this systematic review and meta-analysis is a collection of the newest information combined with previous findings to furthermore illuminate the effects of opium on CVDs. In this systematic review, all observational studies were systematically searched using the main international databases such as PubMed/Medline, Web of Sciences, and Scopus until October 2018. After the quality assessment of the articles, the fixed or random model meta-analysis was used to pool the results. I-square test was used to assess the heterogeneity of the studies. Overall, 41 studies were identified. Based on the random model, the pooled odds ratio (OR) (95% confidence interval (CI)) of opium use and coronary artery diseases (CAD) was estimated at 2.75 (95% CI = 2.04-3.75; I2=47%). The pooled OR of opium use and CVD in-hospital mortality was not statistically significant (OR: 1.44, 95% CI = 0.88-2.36, I2 = 51%). In the stratified analysis, in the patients who had undergone heart surgery, the average of ejection fraction (EF) in the opium users was significantly lower than those not using opium (mean differences: -3.06, CI 95% = -4.40 to -1.71, I2 = 60%) but in the patients with acute myocardial infarction undergoing angiography, the average EF was not significantly different in the opium users compared to non-users (mean difference: 0.30, CI: -0. 55 to 1.15). The results of this meta-analysis revealed that opium might be a risk factor for CAD and EF but not in-hospital mortality.

Cerebrovascular disease: how serum phosphorus, vitamin D, and uric acid levels contribute to the ischemic stroke.

BACKGROUND: Associations between serum phosphorus level and the incidence of ischemic stroke are not clear. This study aimed to measure serum phosphorus, vitamin D3, and uric acid levels in ischemic stroke patients compared to a population without ischemic stroke. METHODS: In this cross-sectional study, 133 patients admitted to a neurology ward with the diagnosis of ischemic stroke were compared with a control group comprising 133 age- and gender-matching individuals. The presence of ischemic stroke was confirmed by a neurologist based on clinical signs, symptoms, brain CT scan, and MRI. Blood samples were taken from all patients in the first 24 h of admission to measure serum phosphorus, vitamin D3, calcium, and uric acid levels. RESULTS: According to the results of this study, uric acid medians in patients with stroke and controls were 4.9 [3.8-6.4] and 3.9 [3.5-4.9] mg/dL, respectively (p < 0.001). Median phosphorus and vitamin D levels were significantly lower in stroke patients than the controls (3.6 [3.02-4.21] vs. 4.2 [3.8-4.6]) and (15.1 [8.2-27.9] vs. 22.7 [10.4-39.2]), respectively. Multiple logistic regression analysis showed that the ischemic stroke was positively associated with the vitamin D level and negatively correlated with the uric acid level. The phosphorus level was not significantly predictive of ischemic stroke. CONCLUSION: Lower serum levels of vitamin D3 and higher levels of uric acid were associated with ischemic stroke. There are still unknowns about the role of these indicators on ischemic stroke and it requires further studies.

Blood lead concentration and its associated factors in preschool children in eastern Iran: a cross-sectional study.

BACKGROUND: Lead is a toxic metal that affects almost every organ in the body. Children are more susceptible to lead toxicity because they ingest non-food items (pica), have oral exploratory habits, absorb more substantial amounts of ingested lead compared to adults, and have a developing central nervous system. This study describes venous blood lead concentrations (BLC) in young children living in Birjand, Iran. METHODS: A cross-sectional study was performed in 2016 on children 1-7 years of age who were referred to healthcare centers in Birjand City. Demographic information was obtained, and their BLC was tested using atomic absorption spectrometry (AAS). RESULTS: Four hundred children were tested. Their mean age was 52.37 ± 23.77 months; their mean BLC was 2.49 ± 2.64 µg/dL (median 1.85 µg/dL). Thirty-two (8%) children had a BLC > 5 µg/dL. A logistic regression model revealed that per one unit of increase in age, the chance of an elevated BLC decreased by 3% (OR (95%CI): 0.97 (0.96-0.99), p < 0.01). The risks of an elevated BLC was 61% lower in girls compared to boys (OR (95%CI): 0.39 (0.17-0.92), p = 0.03). Further, per one rate of increase in the BMI, the chance of an elevated BLC was higher (OR (95%CI): 1.13 (1.02-1.24), p = 0.01). Children whose fathers were laborers had higher BLC than those with employee fathers (p = 0.01). CONCLUSION: Of 400 children aged 1-7 years old living in Birjand, Iran, 8% had elevated BLC. BLC correlated with the child 's age, gender, body mass index, and father's occupation.

Tramadol and the occurrence of seizures: a systematic review and meta-analysis.

Introduction: Tramadol is a synthetic opioid which is commonly used around the world to relieve moderate to severe pain. One of the serious possible complications of its use is seizures. The present study aims to investigate and summarize the studies related to tramadol and occurrences of seizures after tramadol use and factors influencing these seizures.Methodology: Our systematic review is compliant with PRISMA guidelines. Two researchers systematically searched PubMed/Medline, Web of Sciences, and Scopus. Cohort, case-control, cross-sectional studies, and clinical trials. The risk of bias was assessed using the Newcastle-Ottawa Scale After article quality assessment, a fixed or random model, as appropriate, was used to pool the results in a meta-analysis. Heterogeneity between the studies was assessed with using I-square and Q-test. Forest plots demonstrating the point and pooled estimates were drawn.Results: A total of 51 articles with total sample size of 101 770 patients were included. The results showed that seizure event rate in the subgroups of tramadol poisoning, therapeutic dosage of tramadol, and tramadol abusers was 38% (95% CI: 27-49%), 3% (95% CI: 2-3%), 37% (95% CI: 12-62%), respectively. Tramadol dose was significantly higher in the patients with seizures than those without (mean differences: 0.82, CI 95%: 0.17-1.46). The odds for occurrence of seizures were significantly associated with male gender (pooled OR: 2.24, CI 95%: 1.80-2.77). Naloxone administration was not associated to the occurrence of seizures (pooled OR: 0.47, 95% CI: 0.15-1.49).Conclusions: Our results demonstrate that the occurrence of seizures in patients exposed to tramadol are dose-dependent and related to male gender, but not related to naloxone administration. Given that, most of the evidence derives from studies utilizing a cross-sectional design, the association of tramadol with seizures should not be considered to be definitively established.

Increasing the Risk of Stroke by Opium Addiction.

INTRODUCTION: Stroke is among the leading causes of mortality and morbidity in the world. Besides the identified risk factor, Ischemic stroke evidence show drug use develops or exacerbates the atherosclerotic process. The current study aimed at comparing cerebrovascular ultrasounds' changes in addicted and nonaddicted people who developed ischemic stroke. METHODS: In the current cross-sectional study, a total of 133 patients with ischemic stroke who were admitted to Vali-Asr hospital from June 2016 to April 2017 were enrolled. For obtaining the quantitative data, t test or Mann-Whitney test was employed to compare the addict or no-addict groups, as well as, categorical data testing was performed using chi-square test. Also, the multiple logistic regression was used for identifying the factors and the significance level was set at 5%. RESULTS: The current study was performed on 133 patients, among them 41 patients (30.8%) were opium addicted, and 92 patients (69.2%) were nonaddict. The mean [IQR] number of atherosclerotic plaques were significantly higher in opium addicted group in comparison with the nonaddicted group (3.0 [1.0-4.0] versus 1.5 [0.0-3.0], P = .008). The possibility of increasing the number of plaques in addicted patients was 1.42 times higher than the nonaddicted patients (odds ratio (95% confidence interval): 1.42 (1.11-1.81), P = .005). CONCLUSION: The findings demonstrated a significant difference in the vessel stenosis pattern between the addict and nonaddict ischemic stroke groups. To investigate the possible effects of opium use and its associated parameters, ie, dosage, duration of use, and the way of opium use on ischemic stroke, further studies are required.

The reference value of blood lead level among the general adult population of eastern Iran.

The aim of this study to the estimate the lead concentrations in the blood of the adult population in South Khorasan Province, evaluate factors related to high lead blood concentrations and establish lead reference values (RVs) in our study population. In cross-sectional study, 400 people who lived in the province of South Khorasan in 2017 were selected. Demographic information was collected and clinical examinations were performed. As the geometric means, blood lead concentration (BLC) was expressed, 10th, 50th, 90th, and 95th percentiles, and 95% confidence intervals (CI) of the 95th percentile. The upper limits rounded values of the 95% CI with the 95th percentile were applied to calculate RVs. Mean BLC was 6.02 ± 7.41 µg dL-1, median of BLC was 4.4 µg dL-1 (IQR: 2.9-6.5; range 0.9-54.7 µg dL-1). One hundred and twenty-five (31.2%) participants had BLCs between 5 and 10.0 µg dL-1, 40 (10.0%) between 10 and 20.0 µg dL-1, and 15 (3.8%%) over 20 µg dL-1. The RVs for BLC for men and women were 16 [95% CI: 10.13-15.96] µg dL-1 and 15 [95% CI: 9.81-14.45] µg dL-1, respectively. Higher BLCs were significantly associated with age, gender, hemoglobin, white blood cell count, and serum phosphorus concentration. This bio-monitoring study of BLCs in the general population of South Khorasan Province offers important demographic and lifestyle factors-stratified reference data. It is essential to continue efforts to reduce lead exposure.

Empathy and cultural competence in clinical nurses: A structural equation modelling approach.

BACKGROUND: Forgiveness has the potential to resolve painful feelings arising from nurse-patient conflicts. It would be useful to evaluate direct and indirect important factors which are related to forgiveness in order to design interventions that try to facilitate forgiveness. AIM/OBJECTIVE: The purpose of this study was to evaluate the intermediating role of empathy in the cultural competence-forgiveness association among nurses using structural equation modeling. RESEARCH DESIGN: The research applied a cross-sectional correlational design. PARTICIPANTS AND RESEARCH CONTEXT: The study included 380 nurses eight hospitals in southern Iran. ETHICAL CONSIDERATIONS: The Ethics and Research Committee of Birjand University of Medical Sciences approved the study protocol. The voluntary nature of participation was explained consent was obtained from participants, and anonymity was guaranteed. FINDINGS: Most of the participants were married and female and fell in the 20- to 30-year-old category. Most of them (89.5%) had a working experience of 1-10 years. The proposed model showed that nurses' empathy intermediated the association between nurses' cultural competence and forgiveness which has fitted the data acceptably (root mean square error approximation = 0.070; comparative fit index = 0.993; goodness-of-fit index = 0.983; and χ2/df = 2.85). CONCLUSION: Empathy skills and cultural competence training were essential for interventions aimed at increasing the tendency to forgive patients. In such interventions, planners should aim at increasing nurses' cultural competence in order to enhance their empathy toward patients, which can, in turn, lead to a greater wish to forgive patients.

Identifying Risk Factors for Drug Use in an Iranian Treatment Sample: A Prediction Approach Using Decision Trees.

INTRODUCTION AND AIM: Substance abuse exacts considerable social and health care burdens throughout the world. The aim of this study was to create a prediction model to better identify risk factors for drug use. DESIGN AND METHODS: A prospective cross-sectional study was conducted in South Khorasan Province, Iran. Of the total of 678 eligible subjects, 70% (n: 474) were randomly selected to provide a training set for constructing decision tree and multiple logistic regression (MLR) models. The remaining 30% (n: 204) were employed in a holdout sample to test the performance of the decision tree and MLR models. Predictive performance of different models was analyzed by the receiver operating characteristic (ROC) curve using the testing set. Independent variables were selected from demographic characteristics and history of drug use. RESULTS: For the decision tree model, the sensitivity and specificity for identifying people at risk for drug abuse were 66% and 75%, respectively, while the MLR model was somewhat less effective at 60% and 73%. Key independent variables in the analyses included first substance experience, age at first drug use, age, place of residence, history of cigarette use, and occupational and marital status. DISCUSSION AND CONCLUSION: While study findings are exploratory and lack generalizability they do suggest that the decision tree model holds promise as an effective classification approach for identifying risk factors for drug use. Convergent with prior research in Western contexts is that age of drug use initiation was a critical factor predicting a substance use disorder.

Epidemiological and clinical profiles of acute poisoning in patients admitted to the intensive care unit in eastern Iran (2010 to 2017).

BACKGROUND: Acute poisoning is a common chief complaint leading to emergency department visits and hospital admissions in developing countries such as Iran. Data describing the epidemiology of different poisonings, characteristics of the clinical presentations, and the predictors of outcome are lacking. Such data can help develop more efficient preventative and management strategies to decrease morbidity and mortality related to these poisonings. This manuscript describes the epidemiology of acute poisoning among patients admitted to the intensive care unit (ICU) in Birjand, Iran. METHODS: This retrospective, cross-sectional study was conducted to characterize acute poisonings managed in the ICU during a 7-year period from March 2010 to March 2017 in a single center in Birjand, Iran. Patient characteristics, suspected exposure, the route of exposure, and outcome data were collected from hospital medical records. RESULTS: During the study period, 267 (64% male and 36% female) patients met inclusion criteria. Pharmaceutical medication (36.6%), opioids (26.2%) followed by pesticides (13.9%) were the most common exposures 38.2% of these cases were identified as suicide attempts. There were different frequencies in terms of xenobiotic exposure in relation to gender (p = 0.04) and the survival (p = 0.001). There was a significant difference between various xenobiotics identified as the cause of poisoning (p = 0.001). Mortality rate in our study was 19.5%. The incidence of outcomes was significantly higher in patients poisoned with opioids, pesticides, benzodiazepines, and tricyclic antidepressants (p < 0.05). The median length of hospital stay was higher in pesticide-poisoned patients (p = 0.04). CONCLUSION: Opioids and pesticides were the most common exposures. The mortality rate of the poisoned patients in the ICU was proportionately high. The mortality rate due to opioid poisoning is a major concern and the most significant cause death due to poisoning in the region. Further monitoring and characterization of acute poisoning in Birjand, Iran is needed. These data can help develop educational and preventative programs to reduce these exposures and improve management of exposures in the prehospital and hospital settings.

Critical appraisal of fundamental items in approved clinical trial research proposals in Mashhad University of Medical Sciences.

Background: Writing, designing, and conducting a clinical trial research proposal has an important role in achieving valid and reliable findings. Thus, this study aimed at critically appraising fundamental information in approved clinical trial research proposals in Mashhad University of Medical Sciences (MUMS) from 2008 to 2014. Methods: This cross-sectional study was conducted on all 935 approved clinical trial research proposals in MUMS from 2008 to 2014. A valid and reliable as well as comprehensive, simple, and usable checklist in sessions with biostatisticians and methodologists, consisting of 11 main items as research tool, were used. Agreement rate between the reviewers of the proposals, who were responsible for data collection, was assessed during 3 sessions, and Kappa statistics was calculated at the last session as 97%. Results: More than 60% of the research proposals had a methodologist consultant, moreover, type of study or study design had been specified in almost all of them (98%). Appropriateness of study aims with hypotheses was not observed in a significant number of research proposals (585 proposals, 62.6%). The required sample size for 66.8% of the approved proposals was based on a sample size formula; however, in 25% of the proposals, sample size formula was not in accordance with the study design. Data collection tool was not selected appropriately in 55.2% of the approved research proposals. Type and method of randomization were unknown in 21% of the proposals and dealing with missing data had not been described in most of them (98%). Inclusion and exclusion criteria were (92%) fully and adequately explained. Moreover, 44% and 31% of the research proposals were moderate and weak in rank, respectively, with respect to the correctness of the statistical analysis methods. Conclusion: Findings of the present study revealed that a large portion of the approved proposals were highly biased or ambiguous with respect to randomization, blinding, dealing with missing data, data collection tool, sampling methods, and statistical analysis. Thus, it is essential to consult and collaborate with a methodologist in all parts of a proposal to control the possible and specific biases in clinical trials.

Alzheimer's Disease and Circulatory Imbalance of Toxic Heavy Metals: A Systematic Review and Meta-analysis of Clinical Studies.

The role of heavy metals on human health has often been discussed regarding disease pathogenesis and risk factors. Alzheimer's disease (AD), a prevalent neurodegenerative disease, is no exception. We conducted a comprehensive examination to assess the concentrations of lead (Pb), cadmium (Cd), arsenic (As), and mercury (Hg) in biological samples of AD patients in comparison with a group of individuals without AD, with the objective of our study being to perform a systematic review on this topic. We performed this systematic review by searching various databases/search engines, including Web of Science, Scopus, PubMed, and Google Scholar, until December 7, 2022. Relevant studies were scrutinized for eligibility. Meta-analysis was performed on studies with sufficient data using STATA software. Twenty-seven out of 3349 studies met pre-defined eligibility criteria and were included in our systematic review. For the meta-analysis, 22 studies with 3346 participants (1291 AD patients and 2055 healthy controls) had sufficient data for inclusion in the analysis. Using a random-effects model, we found that pooled data indicated patients with AD had significantly higher levels of Cd in their biological samples compared to controls (Hedges' g, 0.83; 95% CI, 0.11, 1.54; p = 0.023). However, other heavy metals were not significantly different in circulatory samples of AD patients compared to healthy controls (p > 0.05). This systematic review and meta-analysis indicated that Cd concentrations in AD patients were significantly higher than in healthy controls. Other included heavy metals may not be directly associated with increased risk of AD.