The Effect of Aloe Vera Clinical Trials on Prevention and Healing of Skin Wound: A Systematic Review.

BACKGROUND: Aloe vera is an herbaceous and perennial plant that belongs to the Liliaceae family and used for many medicinal purposes. The present study aimed to systematically review clinical trials regarding the effect of Aloe vera on the prevention and healing of skin wounds. METHODS: To identify all related published studies, we searched SID, IRANDOC, Google Scholar, PubMed, MEDLINE, Scopus, Cochrane Library, and ScienceDirect databases in both the English and Persian languages from 1990 to 2016. The keywords used were Aloe vera, wound healing, and prevention. All clinical trials using Aloe vera gel, cream, or derivatives that included a control group with placebo or comparison with other treatments were included in the study. The PRISMA checklist (2009) was used to conduct the review. RESULTS: In total, 23 trials that met the inclusion criteria were studied. The results of the studies showed that Aloe vera has been used to prevent skin ulcers and to treat burn wounds, postoperative wounds, cracked nipples, genital herpes, psoriasis, and chronic wounds including pressure ulcers. CONCLUSION: Considering the properties of Aloe vera and its compounds, it can be used to retain skin moisture and integrity and to prevent ulcers. It seems that the application of Aloe vera, as a complementary treatment along with current methods, can improve wound healing and promote the health of society.

The effect of Aloe Vera gel on prevention of pressure ulcers in patients hospitalized in the orthopedic wards: a randomized triple-blind clinical trial.

BACKGROUND: One of the most common orthopedic problems is the incidence of pressure ulcer followed by immobility. This study aimed to investigate the effect of Aloe Vera gel on the prevention of pressure ulcer in patients hospitalized in the orthopedic ward. METHOD: This study is a randomized, triple-blind clinical trial which was done on 80 purposefully selected patients in orthopedic ward in Arak town, Iran, 2016. Patients were randomly assigned into two intervention and control groups based on blocking sampling method. In each group the routine daily cares to prevent bed sores were performed by nurses. In the intervention group in addition to routine nursing care to prevent bed sores, twice a day (hours of 9 and 21) pure Aloe Vera gel on the areas of hip, sacrum and heel were rubbed, but in the control group placebo (gel of water and starch) were used. Then sacral, hip and heel of both groups on days 3, 7 and 10 for of signs of pressure ulcers was evaluated. RESULTS: The mean age of patients in the control group was (42.34 ± 12.19) and in the intervention group Was (41.71 ± 11.50) years, respectively. In the intervention group 1 patient afflicted with sore of hip and two people with sacral pressure ulcer. In the control group 3 patients affiliated with sore of hip, 8 people with sacral pressure ulcer, and 1 person had pressure sore of heel. Analysis of the data showed that both groups had statistically significant differences in the incidence of pressure ulcers (P = 0.047). This means that Aloe Vera gel could prevent the occurrence of pressure ulcers in the intervention group. CONCLUSION: Due to the effect of Aloe Vera gel to prevent a rise in temperature, non-blanchable redness, swelling and pain of the skin of regions under study in hospitalized patients in the orthopedic ward, applying of it toward the prevention of pressure ulcers in patients at risk of pressure ulcer development is recommended. TRIAL REGISTRATION: This study was registered in Iranian Registry of Clinical. Trials in 07/09/2016 with the IRCT ID: IRCT2016051027825N1 .

The Effect of Aromatherapy with the Essential Oil of Orange on Pain and Vital Signs of Patients with Fractured Limbs Admitted to the Emergency Ward: A Randomized Clinical Trial.

BACKGROUND AND OBJECTIVE: Pain is an emotional and unpleasant experience associated with actual or potential tissue damage. The literature shows no study on the effect of aromatherapy with the essential oil of orange on unpleasant feelings of patients with fractured limbs. In this regard, this paper aims at studying the effect of aromatherapy with the essential oil of orange on patients with fractured limbs admitted to the emergency ward. METHODS: Sixty patients admitted to the emergency ward of Vali-e-Asr Hospital were selected by purposive sampling method and then were divided into two groups of control and experiment by block method. This study was done in one shift work (morning or afternoon). Four drops of the orange oil were poured on a pad and were pinned with a plastic pin to the patient's collar, about 20 cm distant from head. The old pad was replaced by the new one every 1 h. The patients' pain and vital signs were checked every 1 h for at last 6 h. The data were analyzed by SPSS Version 21. RESULTS: Forty (66.7%) patients were male and twenty (33.3%) were female. Their age average was 37.93 ± 18.19 years old. The most fractured cases were in the scapular (11 patients [18.3%]). Friedman test showed that pain in the experiment group (P = 0.0001) decreased significantly rather than the control group (0.339). However, in vital signs, there could be found that no significant change between the two groups was seen. CONCLUSION: Aromatherapy with orange oil can relieve pain in patients with fractured limbs but has no effect on their vital signs. Therefore, aromatherapy with orange oil can be used as a complementary medicine in these patients.

The effect of adult coloring (mandala pattern) on pain and anxiety associated with dressing changes in burn patients: A randomized controlled trial.

Introduction: The study investigated the effect of mandala coloring on pain and anxiety associated with dressing changes in burn patients. Method: This clinical trial was conducted on 60 patients in two groups. At the beginning of the study [baseline (T1)], anxiety and pain were assessed using the BSPAS and VAS. A mandala pattern with colored pencils was provided to the patients in the intervention group. Each patient was given 30 min to color. Anxiety was measured at the 35th minute (T2). A dressing change was performed and 15 min later, the variables were measured again (T3). The control group received no intervention. Results: The mean anxiety at the baseline (T1), 35th minute (T2), and 15 min after dressing changes (T3) in the intervention and control groups were 38.73 ± 5.55, 26.20 ± 6.08 and 28 ± 8.53, and 39.17 ± 4.17, 41.27 ± 3.68 and 41.63 ± 2.97, respectively. Anxiety at T1 was at the same for both groups. The anxiety in the intervention group decreased (P < 0.001) at T2 and T3 and increased in the control group. The mean pain intensity at the baseline (T1) and 15 min after dressing changes (T2) in the intervention group was 8.47 ± 1.432 and 5.9 ± 1.9, respectively, and in the control group was 8.33 ± 0.802 and 8.77 ± 0.626. Pain intensity at T1 was at the same level for both groups. The pain in the intervention group decreased at T2 (P < 0.001), whilst it increased in the control group. Conclusion: Mandala coloring can reduce pain and anxiety during dressing changes in burn patients. It can be used as adjuvant treatment. Lay Summary: Wound dressing in burn patients is accompanied by pain. This painful experience can lead to wound dressing anxiety in these patients. For this purpose, a study was conducted to check whether coloring before wound dressing can reduce the pain and anxiety of dressing in adults. Two groups of patients were included in the study; before the dressing, one group received a pre-prepared image of mandela designs along with colored pencils and colored the design to their taste. The other group did not receive any intervention. The intensity of pain and the level of anxiety of the two groups were measured before and after the dressing. The results showed that the coloring of the mandela design before dressing reduced the pain and anxiety related to the proceedure.

The effect of super brain yoga on the cognitive function of hemodialysis patients.

Introduction: Cognitive impairment is one of the most important end-stage consequences of renal disease. This study was conducted to investigate the effect of super brain yoga on the cognitive function of hemodialysis (HD) patients. Methods: This randomized clinical trial was conducted on 60 HD patients who were assigned to the control (n = 30) and intervention (n = 30) groups. In addition to undergoing their routine HD, subjects in the intervention group performed yoga exercises for one month, at least three days a week, once a day. Cognitive function score of the patients at baseline and after the study (one month later) was measured using the Mini-Mental State Examination (MMSE). Data were analyzed using SPSS version 20 using descriptive statistics, including mean and standard deviation, and inferential statistics, including independent t-test, paired t-test, and ANCOVA. Results: The mean score of cognitive function, urea, creatinine, and dialysis adequacy at baseline was 26.07 ± 3.72, 133.83 ± 34.19, 9.37 ± 2.55, and 1.22 ± 0.24 in the control group and28.97 ± 1.62, 174.17 ± 52.8, 13.38 ± 4.16, and 1.26 ± 0.22, in the intervention group, respectively. At the baseline, there was a significant difference between the two groups in terms of cognitive function, urea, creatinine (p-value = 0.001), but there was not in terms of dialysis adequacy (p-value = 0.974). Therefore, the analysis of covariance (ANCOVA) was used to adjust their effects. The mean score of these variables after the study was 25.77 ± 3.11, 146 ± 42.03, 9.7 ± 2.61, and 1.24 ± 0.24 in the control group and 29.17 ± 1.23, 156.03 ± 37.67, 12.27 ± 3.46, and 1.43 ± 0.19 in the intervention group, respectively. There was a significant difference in cognitive function between two the groups (p = 0.05). Conclusion: Super brain yoga exercises seem to play an effective role in improving the cognitive function of HD patients. Therefore, super brain yoga is recommended as a complementary therapy for HD patients in nursing.

The Effect of Distance Empowerment Program on Self-efficacy Among Multiple Sclerosis Patients.

ABSTRACT: BACKGROUND: Multiple sclerosis (MS) is the most common nontraumatic debilitating disease in young adults. This study aimed to determine the effect of distance empowerment programs on self-efficacy in MS patients. METHODS: Sixty-four MS patients participated in this quasi-experimental study. Patients were first entered into the study using the convenience sampling method and then were randomly allocated to control (32) and intervention (32) groups. The intervention group underwent a distance empowerment program (via WhatsApp, Telegram, and blog) and weekly telephone follow-up for 2 months. Self-efficacy was evaluated before, and immediately after, the empowerment program using the MS Self-Efficacy Scale. RESULTS : Data from 59 participants were analyzed. Before implementation of the empowerment program, the mean scores of self-efficacy in the intervention and control groups were not significantly different. After implementing the empowerment program, the mean score of self-efficacy in the intervention group was higher than that of the control group ( P < .05). CONCLUSION : Distance empowerment has an effect on the self-efficacy of patients with MS and may lead to an increase in self-efficacy scores after implementing an empowerment program.

The impacts of head trauma management education on the clinical decision-making of pre-hospital emergency staff.

BACKGROUND: The aim of this study was to compare the effectiveness of head trauma management education by the scenario method versus lecturing on clinical decision-making by pre-hospital emergency staff. MATERIALS AND METHODS: This was an educational trial on 60 pre-hospital emergency staff, performed in Saveh in 2020-2021. The participants fulfilling inclusion criteria entered the study and were randomly allocated to two groups: scenario (n = 30) and lecture (n = 30). Clinical decision-making scores for head trauma patient management were determined at the beginning and end of the study using a researcher-made questionnaire. Data were analyzed using descriptive and inferential statistics and SPSS software version 16. RESULTS: At post-intervention, the mean score of clinical decision-making was 75.28 ± 11.7 in the scenario group and 68.55 ± 11.91 in the lecture group. The results of the independent t-test showed that the mean score of clinical decision-making was significantly higher in the scenario group compared with the lecture group (p = 0.04). The results of paired t-test showed a significant increase in the mean score of clinical decision-making in both groups after the intervention (p < 0.05); however, the mean of increment was higher in the scenario group (9.77 ± 7.63) than in the lecture group (1.79 ± 3). CONCLUSION: Regarding the impact of scenario-based education on learners' intellectual abilities and creativity, it seems that this type of education can be an appropriate alternative to traditional educational methods. Therefore, it is suggested to incorporate this method in the training programs of pre-hospital emergency staff.

Investigating the Effective Factors of Using Personal Protective Equipment from the Perspective of Nurses Caring for COVID-19 Patients: A Cross-Sectional Study.

Considering the importance of appropriate personal protective equipment (PPE) for preventing COVID-19 transmission, the aim of this study was to investigate the factors affecting the use of PPE from the perspective of the nurses caring for COVID-19 patients. This descriptive cross-sectional study surveyed 240 nurses working in the central COVID-19 hospitals of Arak, Iran. Nurses were enrolled in the study by a convenience sampling method. The data collection tool was a validated questionnaire. Data were analyzed by SPSS 16 software using descriptive statistics, analysis of variance (ANOVA), and independent sample t-test. Environmental (4.24 ± 0.45), personal (4.16 ± 0.42), and organizational (4.04 ± 0.50) factors all contribute significantly to nursing attitudes about PPE use (p < 0.05). The average score, combining all identified factors, was 4.15 ± 0.31. The most influential factor contributing to appropriate use of PPE was environmental, while the least impactful parameters were related to rules and regulations. Environmental factors have the greatest impact on the use of PPE from the perspective of the nurses caring for patients with COVID-19. Managers and healthcare organizations should provide appropriate and adequate PPE to nurses, educate them on proper use, and monitor the process to resolve barriers.

Termination of professional responsibility: exploring the process of discharging patients with heart failure from hospitals.

Despite the emphasized importance of the discharge process for patients with heart failure, this process is not taken as seriously as it should be. The objective of this qualitative study is to explore the concept of discharge and its associated factors in 42 experienced patients, family members, nurses and cardiologists at two educational hospitals in Tehran, Iran. The content analysis of the data indicates that the participants consider hospital discharge as the termination of professional responsibility on the part of physicians and nurses as far as health-care support is involved. Three themes were identified as factors related to the treating team, health-care system and patients and their families. Adverse outcomes of inappropriate discharge planning which manifested as incompliance with 'diet and medical regimen' and lack of lifestyle modification were also noted. It seems proper to try and change the attitude of physicians and nurses towards the concept of discharge, and raise their sensitivity to organizing and executing discharge plans. It is also recommended that postdischarge care should be established.

The Effectiveness of Olive Oil in Controlling Morning Inflammatory Pain of Phalanges and Knees Among Women With Rheumatoid Arthritis: A Randomized Clinical Trial.

PURPOSE: This study aimed to determine the effectiveness of olive oil in controlling morning inflammatory pain of phalanges and knees among women with rheumatoid arthritis. DESIGN: This is a randomized clinical trial, which was done in Arak, Iran. METHOD: After selecting 60 women based on a convenience sampling method, they were randomly allocated into five groups. A demographic questionnaire, the Visual Analogue Scale, and the Disease Activity Score 28 were completed. After 12 weeks of interventions, the last two scales were again completed. All data were analyzed using t test, Kruskal-Wallis test, and Friedman test. RESULTS: The mean age of the women was 40 ± 10.5 years. The result of the Friedman test showed a significant difference (p ≤ .001) among the total mean of groups before and after interventions. The post hoc test (least significant difference [LSD]) showed a significant difference (p ≤ .001) between the mean of Disease Activity Score 28 in the group using olive oil for massaging. Results also showed that there are significant differences (p ≤ .001) among the mean of Visual Analogue Scale rates, among the mean of the number of painful joints, and among the mean of the number of swollen joints after intervention in the five groups. CONCLUSION: Applying topical extra virgin olive oil, Piroxicam gel, and paraffin oil; dry massaging; and taking routine drugs alone were all effective in controlling rheumatic arthritis manifestations, respectively. Therefore, applying topical extra virgin olive oil for controlling of inflammatory pain of joints in rheumatic arthritis is recommended. CLINICAL RELEVANCE: In comparison with other medical ointments for RA, olive oil has lower expenditure and is findable in many homes.

Investigating the Effect of Self-Care Training on Life Expectancy and Quality of Life in Patients with Gastrointestinal Cancer under Radiotherapy.

OBJECTIVE: A huge amount of the efforts made by health teams is dedicated to caring for cancer patients. This study has aimed to investigate the effect of self-care training on life expectancy and quality of life (QOL) in patients with gastrointestinal cancer who were under radiotherapy. METHODS: In this clinical trial, 50 patients were selected using the block randomization method. The intervention was performed at Ayatollah Khansari Hospital in Arak, Iran. The patients in the intervention group received three sessions of face-to-face training. The data collection tools included Schneider's Life Expectancy Questionnaire and EORTC QOLQ-C30. Data were analyzed by SPSS version 23. RESULTS: In the control group, 16 were male (64%) and 9 female (36%), and in the intervention group, 14 were male (56%) and 11 were female (44%). Before the intervention, the two groups were homogenous regarding all variables. After the intervention, the mean of QOL was 67 ± 22.62 in the intervention group and 56 ± 18.55 in the control group (P < 0.05). In examining the different dimensions of QOL, improvement in all functional dimensions was observed in the intervention group. After the intervention, the mean score of life expectancy showed a significant difference (P < 0.05) between the intervention group (39.52 ± 5.26) and the control group (31.6 ± 7.13). CONCLUSIONS: It was found that self-care training improved the QOL and life expectancy of patients with gastrointestinal cancer who were under radiotherapy. Therefore, self-care training is recommended to improve the QOL and the life expectancy of cancer patients.

Effectiveness of super brain yoga for children with hyperactivity disorder.

PURPOSE: This study aimed at determining the effectiveness of super brain yoga for children with hyperactivity disorder. DESIGN AND METHOD: This quasiexperimental and interventional research was conducted on 80 school-age children through a pretest-posttest design. RESULTS: Results showed that there was a significant difference between the means of severity of hyperactivity disorder before (75.1) and after the intervention (63.5) (p < .001). PRACTICE IMPLICATIONS: Practicing super brain yoga reduced the symptoms of hyperactivity disorder among the school-age children.

Henna ( Lawsonia inermis) as an Inexpensive Method to Prevent Decubitus Ulcers in Critical Care Units: A Randomized Clinical Trial.

BACKGROUND: Henna has been used to combat various diseases and pathological conditions of the skin. This study aimed to determine the cooling and protecting effects of henna on prevention of decubitus ulcers in critical care units. METHOD: This is a randomized clinical trial. It was conducted on 80 patients hospitalized in intensive care units. Patients were randomly allocated into 2 groups of control and intervention (n = 40) by blocking method. For the intervention group, along with the standard prevention cares for decubitus ulcers, henna was applied with 15 cm extent on the patients' sacrum. RESULTS: At the end of the study, 1 patient in the intervention group (2.7% male) and 6 patients in the control group (14.29% male, 2.85% female) had developed decubitus ulcers; this difference was significant ( P = .001). CONCLUSION: For every patient at risk of developing decubitus ulcers, application of henna as a preventive measure is recommended.

Effectiveness of the "Create Sensitivity" Caring Model on Blood Glucose/ Glycosylated Hemoglobin and Quality of Life in Patients With Type 2 Diabetes.

OBJECTIVE: This study aimed to determine the effectiveness of the "Create Sensitivity" caring model on blood glucose/ glycosylated hemoglobin and quality of life in patients with type 2 Diabetes. METHODS: This study enrolled 70 patients from an educational hospital in Kurdistan, Iran. The model was implemented among the test group over a period of 3 months. Blood glucose/ glycosylated hemoglobin and patients' quality of life were measured before and after intervention. Data were analyzed using version 21 of the statistical software SPSS. RESULTS: After the intervention, significant differences existed between the test and control groups both in blood glucose levels (means, 146.4 ± 51.3 mg/dl and 175.6 ± 59.8 mg/dl, respectively; P=0.032) and in glycosylated hemoglobin (means, 67.89 ± 13.34 mmol/mol and 80.03 ± 17.234 mmol/mol, respectively; P= 0.002). Additionally, there was also a significant difference between the quality of life of the patients in test group (mean, 58.25 ± 5.3) and that in the control group (mean, 47.02 ± 4.5) (P= 0.0001). CONCLUSION: Use of this model was associated with reducing fasting blood glucose and glycosylated hemoglobin and increasing the total mean of quality of life in the patients in the test group. So, the application of this model is recommended.

Exploratory Study of Andropause Syndrome in 40-65 Years in Arak: A Cross Sectional Study.

Objective: Andropause syndrome is caused due to the deficiency in sex hormones and brings about symptoms of physical, psychological, and sexual nature. This study aims at investigating the prevalence of andropause syndrome in 40-65-year-old men in the central city of Iran (Arak). Materials and methods: This study is a descriptive cross-sectional research conducted on 600 men living in the city of Arak in 2017. The subjects were selected through cluster sampling and qADAM was used for collecting data including three areas (level of energy, psychological and sexual). The data were analyzed through descriptive and inferential statistics (independent t-test and ANOVA) and using SPSS 16. Results: The results showed that the average questionnaire score increased with an increase in age up to 50 years and above. Correlation test for the three subscales of physical, psychological, and sexual showed that the psychological subscale had the highest correlation with andropause score (p < 0.05). Among the items related to the subscales, the statement" I feel my sex drive has decreased" with mean and standard deviation of 3.62 ± 1.06 had the highest correlation with andropause and the statement "I feel I have no value for society" with mean and standard deviation of 1.7 ± 0.86 had the lowest correlation with andropause. Conclusion: Andropause age in Arak is 50 years and above. Average questionnaire score showed a positive direct relation with age. Decreased sex drive had the highest correlation and losing social value had the lowest correlation with andropause state.

Cold Dialysis Solution for Hemodialysis Patients With Fatigue: a Cross-over Study.

INTRODUCTION: The purpose of this study was to explore the effect of cold dialysis on fatigue in hemodialysis patients. MATERIALS AND METHODS: In a double-blinded cross-over clinical trial, 46 participants were recruited from a hemodialysis unit in Iran. The participants were allocated into 2 groups through simple random sampling method. Each group received 3 sessions of hemodialysis with a dialysis solution temperature of either 37°C 3 or 35.5°C during the first week and then with for another week with the other temperature.  The self-report Piper Fatigue Scale questionnaire was filled out by the participants. RESULTS: The Piper Fatigue Scale scores in the cold dialysis groups were significantly lower than those in the conventional dialysis solution temperature (P < .001). Reducing the temperature of hemodialysis solution brought a 31.3% reduction in the fatigue score. CONCLUSIONS: Cold dialysis can be used for all hemodialysis patients as a routine intervention, and in particular, it is recommended dialysis patients who have severe fatigue as a convenient and inexpensive therapeutic option.

Addressing disruption in family life: exploration of the perceived needs of the families of patients hospitalized in critical care units in Iran.

BACKGROUND: The stress faced by a family member impacts the whole family. Disease is a stressor that creates crises within families. PURPOSE: This study explores the perceived needs of the families of hospitalized patients in critical care units in the city of Arak, Iran. METHODS: This study used a qualitative design and a content analysis approach. After purposeful sampling, semistructured interviews were held with 16 participants. RESULTS: Using constant comparative analysis, one main theme and eight subthemes emerged from the data. The main theme was "addressing the disruption in family life." The subthemes were "not being fully informed," "not receiving empathy," "feeling insecure," "being mentally unstable," "being concerned about their patient's future," "being dissatisfied with the lack of facilities for the families of patients," "dealing with financial problems," and "having turbulence intrude on family life." CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings of this study underscore that it is important for medical teams to carefully identify and attend to the needs of the family caregivers of hospitalized patients to reduce the disruptive impact of hospitalization on family life.

"Parents a dead end life": The main experiences of parents of children with leukemia.

BACKGROUND: The quantitative studies show that due to the widespread prevalence, high death rate, high treatment expenses, and long hospital stay, leukemia influences the families and their children to a great extent. In this regard, no qualitative study has been conducted in Iran. So, this study was conducted in Arak in 2011 with the aim of expressing the experiences of the parents whose children suffered from leukemia. MATERIALS AND METHODS: Using qualitative research approach, by applying content analysis method, 22 participants were interviewed in two educational hospitals during 2 months. The study was started by purposive sampling and continued by theoretical one. The data were analyzed based on the content analysis method. RESLUTS: Data analysis showed that insolvency, knapsack problems, cancer secrecy, trust on God, self-sacrifice, adaptation, medical malpractice, and hospital facilities were the level 3 codes of parents' experiences and "parents a dead end life" was the main theme of this study. CONCLUSION: In this study, the experiences of the parents whose children suffered from cancer were studied deeply by the use of qualitative method, especially by the use of resources syncretism rather than studying quantitatively. Parents a dead end life emerged as the main theme of this study, emphasizing the necessity of paying further attention to the parents. On the other hand, making more use of parents' experiences and encouraging them helps make the treatment more effective. It is suggested that these experiences be shared with parents in the form of pamphlets distributed right at the beginning of the treatment process.

Lack of sensitivity to readmission: a grounded theory study for explaining the process of readmitting patients suffering from congestive heart failure.

BACKGROUND: Readmission due to congestive heart failure is a global problem during the recent decades; however, little is known about the process of readmission in these patients. AIM: To clarify the readmission process of patients suffering from congestive heart failure in two large referral hospitals in Tehran, Iran. METHOD: A grounded theory approach was utilized. 42 experienced patients, families, nurses and cardiologists participated in the study. Data analysis was carried out over a period of 12months (November 2007 to November 2008). RESULTS: The main concern of participants was "managing the acute problems" of disease. The process of readmission begins with "concentrating on the concern". So, all the participants neglected the patient readmission. Having managed the acute problems, the patients were discharged without a "comprehensive context oriented discharge planning" leading to their return to community without preparation or supporting system. This results in "traditional self-treatment" owing to unhealthy behaviors which brings about the readmission of patients. Neglecting or "lack of sensitivity to readmission" was presented as the core variable. CONCLUSION: In order to control readmission, we recommend those in charge of policy-making for public health to pay particular attention to this variable and taking step such as sensitizing people concerned.