The Relationship Between Spirituality and Religiosity with Death Anxiety Among Cancer Patients: A Systematic Review.

This systematic review aimed to summarize the evidence regarding the relationship between spirituality and religiosity with death anxiety (DA) among cancer patients. This systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) checklist. An extensive search was conducted on electronic databases such as Scopus, PubMed, Web of Science, Iranmedex, and Scientific Information Database (SID) via keywords extracted from Medical Subject Headings from the earliest to February 9, 2022. The quality of the included studies was assessed using the appraisal tool for cross-sectional studies (AXIS tool). Fifteen studies were selected for inclusion in this systematic review. Nine and six studies assessed the relationship between spirituality and religiosity with DA in cancer patients, respectively. Most studies had a negative relationship between spirituality (n = 8) and religiosity (n = 4) with DA. In sum, most studies showed that religion and spirituality are negatively related to DA in patients with cancer.

Investigating the link between organisational justice, positive organisational behaviour and productivity in emergency nurses.

BACKGROUND: Human resource management and employees' performance are fundamental to the success of healthcare organisations. Therefore, it is important to consider the factors that may affect employees' performance. AIM: To determine the relationship between perceived organisational justice, positive organisational behaviour (POB) and the productivity of emergency nurses. METHOD: This was a descriptive-analytical study that involved distributing questionnaires to emergency nurses working in hospitals affiliated with Mazandaran University of Medical Sciences in Iran. The researchers used proportionate stratified sampling to calculate the sample size. Three questionnaires were used to collect data on organisational justice, POB and productivity. The data were analysed using the Pearson correlation coefficient and multiple regression tests. RESULTS: The questionnaires were distributed to 284 emergency nurses and completed by 234 of them. The results demonstrated a significant relationship between the productivity of the emergency nurses and the variables of perceived organisational justice and POB. CONCLUSION: Higher levels of perceived organisational justice and POB in the ED setting are likely to lead to increased productivity among emergency nurses, and as a result the quality of patient care is likely to improve. Therefore, healthcare organisations should pay particular attention to the application of organisational justice, with the aim of promoting POB among nurses and increasing their productivity.

Evaluation and improvement of the resilience of a transportation system against epidemic diseases: A system dynamics approach.

The influential role of health protocols in preventing the spread of the COVID-19 disease has led governments to seek effective methods for implementing these protocols in the society. Considering the importance of public transportation system in spread of viruses, this paper introduces and analyzes some methods of inspecting urban public transportation companies using system dynamics approach. First, the base model, which represents the status of a public transportation terminal, was created and validated using a system dynamics simulation approach. Then the impact of two penalty policies, including fixed penalty policy (FPP) and variable penalty policy (VPP) on the violations within the terminal was investigated. The simulation results show that the variable penalty policy significantly reduces the violations of passenger terminal drivers. Next, the extended model was developed which considered several terminals. Finally, by presenting two policies of fixed inspector assignment (FIA) and variable inspector assignment (VIA), the effect of four scenarios of combining inspection and penalties policies was investigated. The simulation results showed that combining the variable penalty and variable inspector assignment policies could significantly reduce terminal violations. Also, the implementation of this policy does not require an additional inspector. The results can help city managers to adopt appropriate inspection policies.

The impact of inspection policies on reducing disease prevalence in public buildings: A systems dynamics approach.

The occurrence of the COVID-19 pandemic revealed new dimensions of urban resilience to communities. Failure to implement health protocols in public buildings has had a significant impact on the spread of the disease, and inspection has become necessary to enforce the rules. This study presents different inspection policies of public buildings to reduce disease prevalence. It evaluates and compares the implementation of these policies in the long run based on the systems dynamics approach. First, baseline modeling was performed without inspection to analyze the proposed policies, and disease prevalence was investigated. Then various proposed inspection and fines policies, including fixed inspection and fines rate (FIFF), fixed inspection rate with the variable fine rate (FIVF), and variable inspection and fines rate (VIVF), are introduced, and their system dynamics models are presented. The impact of each inspection policy on the violations rate and disease prevalence in public buildings has been investigated using long-term simulation. Based on the results, regulatory agencies can significantly reduce the rate of violations in public buildings and improve urban resilience to the epidemic by adopting proper inspection policies. The results can help city managers to adopt appropriate inspection policies.

Mental health of the people of northern Iran during the quarantine time of 2020 following the coronavirus epidemic.

BACKGROUND: Coronavirus (COVID-19) is an infectious respiratory disease. Quarantine is often accompanied by unpleasant experiences for those who go through it. The aim of this study was to determine the mental health status of people during quarantine in northern Iran. MATERIALS AND METHODS: This cross-sectional study was conducted during the quarantine period of coronavirus. Conventional sampling was done from March 6 to April 6. Six hundred and forty-two individuals were included. Inclusion criteria were living in Sari and being home quarantined during the corona outbreak. Exclusion criteria included hospitalization history due to corona and unwillingness to participate in the study. In this study, the General Health Questionnaire-28 was used online to collect the required data. To analyze the data, descriptive and inferential statistics (t-test, analysis of variance, and correlation coefficient) were used. RESULTS: In this study, individuals were included in the investigation with a mean age of 38.74 ± 11.89 (ranged from 15 to 73). Most of the participants were female (72.85%) and married (71.34%). According to the results, 21.5% of the participants had poor mental health. Mean mental health scores have a statistically significant relationship with gender, marital status, education, occupation, quarantine period, patients with corona, and exposure to a patient with corona (P ≤ 0.05). Furthermore, a negative correlation coefficient was observed between age and mental health score (correlation coefficient = -0.31, significance >0.001). CONCLUSION: The average score of mental health has a significant relationship with gender, marital status, education, occupation, quarantine period, corona, and exposure to a patient with corona. Given the high prevalence of mental disorders in people during the COVID-19 epidemic, educating people and planning to reduce the psychological effects of the epidemic can be helpful.

A game-theoretic approach for decision analysis in end-of-life vehicle reverse supply chain regarding government subsidy.

The presence of end-of-life vehicles (ELV) in the cities creates irreparable damage in environmental and economic terms. Thus, governments have been searching for ways to collect ELVs. An effective way to address ELVs is subsidies' policy. In this study, a supply chain including an ELV take-back center, an inspection center, and a repair center are considered. The decision variables are the purchase price of the ELVs, the sale price of the repaired vehicle, and the level of vehicle repair. In this supply chain, the government pays a subsidy to take-back centers that deliver their used vehicles. A Stackelberg game structure is considered with the government as the leader, the inspection center as the primary follower, and the collection and repair centers as the second followers. Using the game theory approach, the effects of government subsidies on equilibrium values of the decision-making variables of the centers in the ELV supply chain have been investigated in three scenarios. The scenarios comprise profit sharing, revenue sharing, and a centralized (cooperative) scenario. The results indicate that the centralized scenario has the most significant advantage compared to the two contracts of profit sharing and cost sharing. For example, the repair level of the ELVs, the amount of repaired vehicles demand, consumer surplus, and the whole supply chain's profit are at their maximum. The most significant impact of subsidy payment is related to the take-back center's profit and the ELV supply. On the other hand, the subsidy does not affect the profit of the repair center.

Potential cytotoxic and anti-metastatic effects of berberine on gynaecological cancers with drug-associated resistance.

Gynaecological disorders, such as cervical, ovarian, and endometrial cancers are the second most prevalent cancer types in women worldwide. Therapeutic approaches for gynaecological cancers involve chemotherapy, radiation, and surgery. However, lifespan is not improved, and novel medications are required. Among various phytochemicals, berberine, a well-known natural product, has been shown to be a promising cancer chemopreventive agent. Pharmacokinetics, safety, and efficacy of berberine have been investigated in the several experiments against numerous diseases. Here, we aimed to provide a literature review from available published investigations showing the anticancer effects of berberine and its various synthetic analogues against gynaecological disorders, including cervical, ovarian, and endometrial cancers. In conclusion, berberine has been found to efficiently inhibit viability, proliferation, and migration of cancer cells, mainly, via induction of apoptosis by both mitochondrial dependent and -independent pathways. Additionally, structural modification of berberine showed that berberine analogues can improve its antitumor effects against gynaecological cancers.

The Effect of Warm Footbath on the Quality of Sleep on Patients with Acute Coronary Syndrome in Cardiac Care Unit.

Introduction: This study aimed to determine the effect of warm footbath before bedtime on the quality of sleep on patients with acute Coronary Syndrome in Cardiac Care Unit. Methods: This study was conducted on 120 patients admitted to CCU at Mazandaran Heart Center and randomly divided into two groups of intervention and control. In the intervention group, warm footbath was performed after the second night in hospital before bed time by 41 C water for 20 minutes for three consecutive nights; in contrast, the control group did not receive anything of this sort. The next day, St Mary's Hospital Sleep Questionnaire was completed to evaluate sleep quality. Then, the obtained data were analyzed using SPSS software and Friedman, Wilcoxon exact statistical tests. Results: The quality of sleep in the first night of hospitalization was different from the third night after the intervention in both groups and the improvement process of sleep quality was observed in both groups. Most patients had moderate impairments (23-36), which had not changed during the intervention. In intervention groups, 8 patients had severe sleep disorders (greater than 37), which declined to 1 after three nights of intervention. While, in the control group this number fell from 10 patients with severe sleep disorders to 5. Warm footbath had a great positive impact on patients suffering from severe sleep disorders (P<0.05). Conclusion: Although warm footbath did not improve the quality of sleep in all patients, it reduced the number of patients who had severe sleep disturbances.

Exploring the Human Factors Affecting Health Service Managers: A Qualitative Study.

BACKGROUND: In recent decades, managing health-service systems has faced multiple challenges. Identifying and resolving these challenges promote the efficiency and effectiveness of hospital activities. AIM: The present study aimed to explore the human factors affecting health service managers. MATERIAL AND METHODS: In this qualitative study, in-depth unstructured interviews were conducted with 29 employees who were in close contact with the health service managers. All the interviews were transcribed verbatim. Data were collected using purposeful sampling and were analysed using conventional content analysis via MAXQDA software. RESULTS: A group of 29 participants were interviewed (male 65.5%, female 34.4%). "Managing managers" has been identified as the primary theme with four supporting secondary themes including the inappropriate appointment of managers, the impact of human and social needs of managers, influential employees, and disrupting organisational communications. These are the challenges faced by managers in managing human resources in health-service organisations. CONCLUSION: Results showed that employees manage their managers within the organisation so that they can prevent managers from concentrating on their management affairs and tasks resulting in the distortion of management practices. The results of this study can help the key policy makers and planners in health-service organisations to guide the organisation to pursue its goals through appointing appropriate managers and identifying influential employees.

Common Causes of Eye Enucleation among Patients.

BACKGROUND: We investigated the contributing causes and factors leading to eye enucleation procedure among the patients referred to the ophthalmology clinic of the Center Eye Hospital in Tehran, Iran. PATIENTS AND METHODS: We retrospectively analyzed the clinical records of patients referred to the ophthalmology clinic of the Center Eye Hospital in Tehran, Iran, in the past 3 years. The data retrieved were analyzed. RESULTS: A total of 313 patients underwent eye enucleation during the past 3 years. The average age of the patients was 36.7 years (range: 20-44 years). Two hundred and eight patients (66.5%) were males and 105 (33.5%) were females. One hundred and sixty-nine patients had the right eye enucleation while 144 patients had the left eye enucleation. The various procedures included enucleation (83%), evisceration (13.4%), and exantration (3.6%). The factors leading to these procedures included trauma (33.2%), phthisis bulbi (20.7%), tumors (15.7%), and infections (10.5%). CONCLUSION: In our study population, trauma was the main factor leading to eye enucleation. Hence, measures to increase social awareness and knowledge to reduce trauma cases are necessary as a preventive approach to reduce eye enucleation procedures. Concurrently, ophthalmologists should also pay more attention in early diagnoses and screening of eye health, especially detecting tumor cases such as retinoblastoma and postsurgical care to reduce secondary infections will be effective actions to reduce the overall rate of enucleation.

The study of the relationship between value creation and customer loyalty with the role of trust moderation and customer satisfaction in Sari hospitals.

BACKGROUND: Healthcare providers are competitive, owing to heightened customers' awareness and expectations of health care services. OBJECTIVE: The aim of this study was to determine the relationship between customer value creation and loyalty with mediator trust and customer satisfaction. METHODS: This is a cross sectional survey study. Participants were 196 patients referred to private hospitals in Sari city, Iran from May to June 2014 which were selected by convenience sampling method. Data were collected using questionnaires. Data were analyzed using the structural equation modeling software Smart PLS. RESULTS: The results revealed a relationship between customer value creation and customer loyalty in a Sari city private hospital, and customer satisfaction and trust, mediate the relationship between customer value creation and customer loyalty. The results also revealed significant positive relationship between customer satisfaction and trust (p=0.000 r=0.585). CONCLUSION: customer satisfaction and trust mediate the relationship between customer value creation and customer loyalty.

The Relationship between Religious Coping and Self-Care Behaviors in Iranian Medical Students.

In recent years, researchers have identified that coping strategies are an important contributor to an individual's life satisfaction and ability to manage stress. The positive relationship between religious copings, specifically, with physical and mental health has also been identified in some studies. Spirituality and religion have been discussed rigorously in research, but very few studies exist on religious coping. The aim of this study was to determine the relationship between religious coping methods (i.e., positive and negative religious coping) and self-care behaviors in Iranian medical students. This study used a cross-sectional design of 335 randomly selected students from Mazandaran University of Medical Sciences, Iran. A data collection tool comprised of the standard questionnaire of religious coping methods and questionnaire of self-care behaviors assessment was utilized. Data were analyzed using a two-sample t test assuming equal variances. Adjusted linear regression was used to evaluate the independent association of religious copings with self-care. Adjusted linear regression model indicated an independent significant association between positive (b = 4.616, 95% CI 4.234-4.999) and negative (b = -3.726, 95% CI -4.311 to -3.141) religious coping with self-care behaviors. Findings showed a linear relationship between religious coping and self-care behaviors. Further research with larger sample sizes in diverse populations is recommended.

Comparison of Glasgow Coma Scale, Full Outline of Unresponsiveness and Acute Physiology and Chronic Health Evaluation in Prediction of Mortality Rate Among Patients With Traumatic Brain Injury Admitted to Intensive Care Unit.

BACKGROUND: Traumatic brain injury (TBI) is a common cause of mortality and disability worldwide. Choosing an appropriate diagnostic tool is critical in early stage for appropriate decision about primary diagnosis, medical care and prognosis. OBJECTIVES: This study aimed to compare the Glasgow coma scale (GCS), full outline of unresponsiveness (FOUR) and acute physiology and chronic health evaluation (APACHE II) with respect to prediction of the mortality rate of patients with TBI admitted to intensive care unit. PATIENTS AND METHODS: This diagnostic study was conducted on 80 patients with TBI in educational hospitals. The scores of APACHE II, GCS and FOUR were recorded during the first 24 hours of admission of patients. In this study, early mortality means the patient death before 14 days and delayed mortality means the patient death 15 days after admitting to hospital. The collected data were analyzed using descriptive and inductive statistics. RESULTS: The results showed that the mean age of the patients was 33.80 ± 12.60. From a total of 80 patients with TBI, 16 (20%) were females and 64 (80%) males. The mortality rate was 15 (18.7%). The results showed no significant difference among three tools. In prediction of early mortality, the areas under the curve (AUCs) were 0.92 (CI = 0.95. 0.81 - 0.97), 0.90 (CI = 0.95. 0.74 - 0.94), and 0.96 (CI = 0.95. 0.87 - 0.9) for FOUR, APACHE II and GCS, respectively. In delayed mortality, the AUCs were 0.89 (CI = 0.95. 0.81-0.94), 0.94 (CI = 0.95. 0.74 - 0.97) and 0.90 (CI = 0.95. 0.87 - 0.95) for FOUR, APACHE II and GCS, respectively. CONCLUSIONS: Considering that GCS is easy to use and the FOUR can diagnose a locking syndrome along same values of subscales. These two subscales are superior to APACHI II in prediction of early mortality. Conversation APACHE II is more punctual in the prediction of delayed mortality.

Submental intubation in maxillofacial fracture: a case report.

It can be challenging to create a safe airway in maxilla facial fracture and some skull surgeries. In this case study, the patient experienced jaw fractures that disturbed the dental occlusion and associated fracture of the base of the skull. Neither nasal nor oral intubation was possible based on the side effects of tracheotomy; therefore, submental intubation was applied successfully. The procedure and results are presented in the text.

Social Support in Relation to Fatigue Symptoms Among Patients with Multiple Sclerosis.

BACKGROUND AND AIM: The psychological changes and physiological limitations during multiple sclerosis (MS) disease diminish the social relations. Consequently, losing social supports leads to more physical and psychological complications such as fatigue syndromes. Therefore, this study aimed to investigate the relationship of social support and fatigue syndromes in MS patients. METHODS: This study was a descriptive-analytic which randomly selected 46 patients with MS. The patients evaluated through demographic information, standard modified social support scale, fatigue severity scale, modified fatigue impact scale, and fatigue descriptive scale. Gathered data analyzed using descriptive and inferential statistical Pearson's correlation coefficient. RESULTS: Mean score for variables were as following: Fatigue severity 4/3 ± 1/6, perceived fatigue 34/6 ± 19/5, quality of fatigue 62 ± 3/9, and social support 65/6 ± 23/1, respectively. According to the Pearson statistical test, there was signification association between social support with fatigue severity (P = 0.002 and r = -0.474), fatigue perception (P = 0.001 and = -0.478), and fatigue perception sub-scales, i.e. physical (P = 0.005, r = -0.432), cognitive (P = 0.003, r = -0.0457), and psychosocial (P = 0.009, r = -0.341), respectively. However, there was not significant relationship between social support and fatigue quality (P = 0.59). CONCLUSION: According to the results of current study, all aspects of social support can impact fatigue symptoms in MS patients. Therefore, it is suggested to develop educational programs for caregivers of patients to improve the mental and physical quality of life of patients.

Effectiveness of discharge-planning on physical quality of life of patients with ischemic heart disease.

BACKGROUND AND AIM: One of the goals of health care team is to improve the quality of life of patients during and after hospitalization period. Therefore, this study aimed to examine the effect of performing discharge planning on ischemic heart disease patient's physical quality of life. METHODS: This quasi-experimental study was performed on 74 ischemic heart disease patients which randomly allocated to discharge-planning group (n = 37) and usual care group (n = 37). The discharge-planning included the patients' educational needs, self-care instructions for patients, and caregivers. This program was performed through supporting patients during hospitalization and after discharge. The physical aspect of quality of life was assessed by standard questionnaire Short Form 36 and the data were analyzed through Mann-Whitney, independent t-test, variance analysis, Friedman and Wilcoxon. RESULTS: There was no significant difference between intervention and control groups in physical aspects of the quality of life before intervention (P = 0.423) while two groups were significantly different after intervention (P = 0.000) and quality of life of patients in the case group improved significantly. CONCLUSION: Applying the discharge-planning program as an effective, efficient, cost-effective, and noninvasive intervention on physical aspects of the quality of ischemic heart disease patients' lives is useful and helpful. Hence, it is recommended to use this program to promote and improve the quality of ischemic heart disease patients' lives.

Prevalence of postoperative pressure ulcer: A systematic review and meta-analysis.

INTRODUCTION: A pressure ulcer is a serious safety issue in healthcare systems. The patient's rate of infection with an ulcer, especially a postoperative ulcer, is critical, as it is dictated by factors such as being in a fixed position during surgery, the type of anesthesia used, the duration of surgery, and patient-related factors. The present study was conducted to carry out a systematic assessment of the prevalence of a postoperative pressure ulcer and to find its general prevalence using a meta-analysis. METHODS: The researchers searched databases, including PubMed, Google Scholar, Scopus, Science Direct, the Thomson Reuters' Web of Science (WOS). For English articles published online between January 2000 and October 2015 on the subject of a pressure ulcer, a total of 19 articles were ultimately selected based on the study inclusion criteria. Then results were analyzed in Stata-11. RESULTS: The 19 articles qualified for entering the meta-analysis examined a total of 9527 patients. The studies estimated the general prevalence of a postoperative pressure ulcer as 18.96% (CI 95%: 15.3-22.6); the prevalence by gender was reported as 10.1% (CI 95%: 7.2-13.01) in men and 12.8% (CI 95%: 8.3-17.2) in women. Stage 1 ulcer had a 17.02% prevalence (CI 95%: 11.04-22.9), stage 2 a 6.7% prevalence (CI 95%: 3.8-9.7), stage 3 a 0.9% prevalence (CI 95%: 0.2-1.6), and stage 4 a 0.4% (CI 95%: -0.05-0.8) prevalence. CONCLUSION: The prevalence of a postoperative pressure ulcer is high among the entire population; however, it is still higher in women than in men. The prevalence of a stage 1 ulcer is higher than the prevalence of the other stages of an ulcer.

Common causes of red eye presenting in northern Iran.

AIM: This study aimed to determine the causes of red eye disease among patients of Mazandaran-Northern Iran. METHODS: This cross sectional study included 840 patients who referred to eye clinics with ocular complaints. A detailed history of patients was recorded and their eyes were examined. Then, pre designed checklists were completed by the researcher. RESULTS: The most common cause of red eye was conjunctivitis - 30% (252/ 840), foreign bodies 23.2%, trauma including penetrating or blunt 8.6%, respectively. There was a significant relationship between the red eye trauma, with acute onset and duration of less than a week (P=<0.0001). Diagnoses of red eye were conjunctivitis in 31.3% of the cases separately, viral causes (19.5%), allergic (7%) and bacterial (4%), foreign bodies 22.9%, pterygium 7%, and trauma 6.5%, respectively. CONCLUSION: In the current study, the most common causes of red eyes were conjunctivitis, foreign bodies, and trauma respectively. Red eye was more common in males than in females. An appropriate and proper training of risky factors of red eyes in the future could reduce the risk of serious visual problems.

Effect of acupressure with valerian oil 2.5% on the quality and quantity of sleep in patients with acute coronary syndrome in a cardiac intensive care unit.

The purpose of this three-group double-blind clinical trial study was to investigate the effect of acupressure ( zhǐ ya) with valerian ( xié cǎo) oil 2.5% on the quality and quantity of sleep in patients with acute coronary syndrome (ACS) in a coronary intensive care unit (CCU). This study was conducted on 90 patients with ACS in Mazandaran Heart Center (Sari, Iran) during 2013. The patients were randomly assigned to one of three groups. Patients in the acupressure with valerian oil 2.5% group (i.e., valerian acupressure group) received bilateral acupoint ( xué wèi) massage with two drops of valerian oil for 2 minutes for three nights; including every point this treatment lasted in total 18 minutes. Patients in the acupressure group received massage at the same points with the same technique but without valerian oil. Patients in the control group received massage at points that were 1-1.5 cm from the main points using the same technique and for the same length of time. The quality and quantity of the patients' sleep was measured by the St. Mary's Hospital Sleep Questionnaire (SMHSQ). After the intervention, there was a significant difference between sleep quality and sleep quantity in the patients in the valerian acupressure group and the acupressure group, compared to the control group (p < 0.05). Patients that received acupressure with valerian oil experienced improved sleep quality; however, this difference was not statistically significant in comparison to the acupressure only group. Acupressure at the ear spirit gate ( shén mén), hand Shenmen, glabella ( yìn táng), Wind Pool ( feng chí), and Gushing Spring ( yǒng quán) acupoints can have therapeutic effects and may improve the quality and quantity of sleep in patients with ACS. Using these techniques in combination with herbal medicines such valerian oil can have a greater impact on improving sleep and reducing waking during the night.

The effectiveness of lavender essence on strernotomy related pain intensity after coronary artery bypass grafting.

BACKGROUND: Considering the side effects of pharmacological methods, there has been a suggestion to use nonpharmacological methods such Aromatherapy following coronary artery bypass grafting (CABG). This study aims to evaluate the effectiveness of lavender 2% aromatherapy on sternotomy pain intensity after coronary artery bypass graft surgery in patients who have undergone surgery. MATERIALS AND METHODS: During this clinical trial, 50 patients who were candidates for CABG, were randomly divided into two equal groups, that is, the control group (n = 25) and the case group (n = 25). Following CABG, the case group received two drops of 2% lavender oil every 15 minutes with supplemental oxygen and the control group received only supplemental oxygen through a face mask. The data collection tools comprised of the demographic check list and visual analog scale (VAS) for evaluating the pain intensity. The pain intensity were assessed pre- and five, 30, and 60 minutes post aromatherapy. The final data were analyzed by the t-test and chi-squared test. RESULTS: The findings showed that the pain perception intensity in the case group was lower than that in the control group at the 30- and 60-minute phases after intervention (P < 0.0001). CONCLUSION: The result indicated that aromatherapy can be used as a complementary method in postoperative pain reduction, as it reduced pain. The patients require two sedative drugs, and moreover, it avoids expenses of treatment.