Effect of aromatherapy with rose essential oil on the nausea and vomiting in chemotherapy patients: a randomized controlled trial.

Background: The present study aims to determine the effect of aromatherapy with rose essential oil on the rate of nausea and vomiting in chemotherapy patients. Materials and methods: This randomized controlled trial included 66 cancer patients who were randomly divided: the rose essential oil aromatherapy group (n=33) and the control group (n=33). The sampling period ranged from November 2022 to March 2023. The state of nausea and vomiting was assessed using the Visual Analog Scale. Results: The average scores of nausea and vomiting of both the second and third cycle in three time periods after chemotherapy (first, second, and third six hours) were significantly lower in the intervention group than the control group (P<0.001). Also, in the second cycle of chemotherapy, unlike the third cycle of chemotherapy, there was a significant interaction between group and time (ηp2=0.100, P=0.001, F (84.70, 1.37) = 6.91). In other words, the amount of difference between the mean scores of nausea and vomiting of the two control and intervention groups depended on the variable levels of time and vice versa. Conclusion: The results indicate the reducing effect of aromatherapy with rose essential oil on the severity of nausea and vomiting after chemotherapy in cancer patients. Therefore, it is recommended to be used in chemotherapy to reduce the severity of nausea and vomiting according to the patient's condition.

Frontline nurses experiences about human caring during pandemic of COVID-19: A directed content analysis study.

AIM: This study aims to investigate experiences of frontline nurses about human caring during COVID-19 pandemic based on the Ten Caritas Processes® of Watson's Human Caring Theory. DESIGN: A directed content analysis was performed. METHODS: A total of 15 frontline nurses were recruited by purposive sampling from Razi hospital (north of Iran), in 2020 and semi-structured interviews were conducted. RESULTS: Extracted categories based on Ten Caritas Processes® included feeling satisfied in providing care to patients, effective presence with patients, moving towards self-actualization (moving towards transcendence), care with trust and compassion, experience positive and negative emotions, creativity in providing care, self-directing learning experience in the field of care, unfavourable environment for providing care, feeling acceptance and worth, uncertainty (facing the unknown). This study showed that communication skills, self-sensitivity, patient dignity, teaching-learning and problem-solving skills, holistic attention to the patient, and the provision of a healing environment are necessary for patient care.

Effects of Flaxseed Oil and Olive Oil on Markers of Inflammation and Wound Healing in Burn Patients: A Randomized Clinical Trial.

Objectives: To study the anti-inflammatory and antioxidant effects of flaxseed oil and olive oil on inflammatory markers for facilitating wound healing. Methods: One hundred and twelve patients were randomly selected to four groups with a total burn surface area (TBSA) of 20-50%. The four groups includes olive oil (OO), flaxseed oil (FO), mixture of olive oil and flaxseed oil (OF), and control group and received 30g of oils for three weeks. Serum high-sensitivity C-reactive protein (hs-CRP), ferritin and albumin level as inflammatory markers, as well as cholesterol, triglyceride, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) as the lipid profile were explored. Wound healing was assessed by photographing on days 2, 8, 15, and 22 (during three weeks of intervention) and were analyzed in imageJ software. Results: The greatest reduction in the level of hs-CRP and ferritin was observed in the OF (-21.38±44.41) (-132.79±165.36), while the lowest reduction was reported in the control group (-36.36±79.03) (141.08±262.36). Compared to control group, OO significantly increased albumin (0.88±0.65). Reduction of wound healing at the end of the first week of intervention was not significant in the study groups. However, the stereology examination showed significant improvement in wound healing at the end of the second and third weeks in the OF. Conclusion: Based on the findings, combination of herbal oils reduce inflammation and improve wound healing and showed positive effects on the size of wounds in burn patients.

Prevention of central line-associated bloodstream infections: ICU nurses' knowledge and barriers.

BACKGROUND: Central line-associated bloodstream infections (CLABSI) have been a significant challenge in care, increasing healthcare costs and leading to adverse outcomes, including mortality. AIM: The present study aimed to assess the knowledge of intensive care unit (ICU) nurses on the prevention of CLABSI and the implementation barriers of evidence-based guidelines in practice. DESIGN: A cross-sectional study. METHODS: Data were collected from adult, paediatric, and neonatal ICU nurses working in seven hospitals in Iran, using census sampling from April to July 2020. RESULTS: A number 209 out of 220 ICU nurses participated in the present study (response rate of 95%). The median score of knowledge of ICU nurses towards the prevention of CLABSI was 3.00 out of 11. 50.72% of ICU nurses had insufficient knowledge. The most critical implementation barriers of evidence-based guidelines were high workload, shortage of necessary equipment, and lack of CLABSI prevention workshops. CONCLUSIONS: Overall, the knowledge of ICU nurses towards the prevention of CLABSI was insufficient. Study findings suggest that the knowledge of ICU nurses may be improved by reducing the workload, increasing the number of nursing staff in the ICU, having an adequate supply of equipment needed to ensure safe practice in the ICU, and providing regular related educational workshops for nurses working in the ICU. RELEVANCE TO CLINICAL PRACTICE: The present study's findings suggest that regular training programs should be developed to improve the knowledge of ICU nurses in the care and prevention of CLABSI. Nursing policymakers and managers need to identify and address implementation barriers of evidence-based guidelines to improve nursing, such as high workload, shortage of necessary equipment, and lack of CLABSI prevention workshops.

Perceived spiritual care competence and the related factors in nursing students during Covid-19 pandemic.

Background: Spirituality is defined as the way people experience, express, and seek meanings. It is a major concept in the field of nursing care. Nursing students who are trained and exposed to patients' spiritual care will be better able to take care of their patients' spiritual needs. Objectives: The study aimed to assess perceived spiritual care competence and the related factors in nursing students during the Covid-19 pandemic. Methods: This was a cross-sectional study. The participants were 191 undergraduate nursing students at Guilan University of Medical Sciences (GUMS) that were entered into the study from July 29 to December 21, 2021. The spiritual care competence scale was used to measure spiritual care competence in the participants. It is a 27-item questionnaire with six dimensions including assessing and implementing spiritual care, professionalism and improving the quality of spiritual care, personal support and patient counseling, referral to professionals, attitude towards patient's spirituality, and communication. Data was collected using the convenience sampling method. Data analysis was done by SPSS software version 16.0 using descriptive, bivariate, and multivariate methods. Results: The mean total score of spiritual care competency was 106.8 (SD = 13.4). The mean total score of spiritual care competency was significantly higher in the native students (P = 0.031) and the students with experience of jobs in hospitals (P = 0.037). Conclusion: The findings indicated an acceptable level of performance in nursing students in spiritual care during the Covid-19 pandemic.

The effect of clinical guideline education on the knowledge and practice of nurses for peripheral intravenous catheter placement based on short message service: A quasi-experimental study.

BACKGROUND: Peripheral intravenous catheter (PIVC) placement is the most common invasive clinical procedure, often performed by nurses in hospitals worldwide. This study aimed to assess the effect of clinical guideline education on the knowledge and practice of nurses for PIVC placement based on short message service (SMS). METHODS: In a quasi-experimental study with parallel groups, 66 nurses working in two general university hospitals in Iran were enrolled. Data was collected from 2017 to 2018. PIVC placement was assessed before, immediately, and 4 weeks after educational intervention based on SMS (twice a day for 10 days). RESULTS: Nurses' knowledge score immediately after intervention versus before intervention was higher in the intervention group than in the control group (4.48 vs -0.70; p < 0.001). Nurses' knowledge score in 4 weeks after intervention versus immediately after intervention was lower in the intervention group than in the control group (0.03 vs 0.42; p = 0.014). Nurses' knowledge scores 4 weeks after intervention versus before intervention was higher in the intervention group than in the control group (4.52 vs -0.27; p < 0.001). Nurses' practice score immediately after intervention versus before intervention was higher in the intervention group than in the control group (0.57 vs -0.18; p = 0.174). Nurses' practice score 4 weeks after intervention vs immediately after intervention was higher in the intervention group than in the control group (-0.10 vs -0.38; p = 0.046). Nurses' practice scores 4 weeks after intervention versus before intervention was higher in the intervention group than in the control group (0.47 vs -0.56; p = 0.001). CONCLUSION: Educational intervention by SMS had a significant effect on increasing the knowledge and practice of nurses toward clinical guidelines for PIVC placement. Therefore, it is suggested that educational intervention by SMS be conducted to improve nurses' knowledge as an effective educational method.

Mental Health and Resilience among Nurses in the COVID-19 Pandemic: A Web-Based Cross-Sectional Study.

Objective: Nurses exposed to COVID-19 could be psychologically stressed. The present study investigated the mental health and the resilience level in the nurses' population. Method: This cross-sectional study was performed on 432 nurses in 27 hospitals working in Guilan province, north of Iran, between April 29, to May 14, 2020. Mental health and resilience were measured using the 12-item General Health Questionnaire-12 (GHQ-12) and the 10-item Connor-Davidson Resilience Scale (CD-RISC-10). Hierarchical multiple linear regression model was used to identify factors associated with mental health. Results: The mean GHQ-12 and CD-RISC-10 scores were 15.72 (SD, 5.67) and 25.97 (SD, 6.88), respectively. Probable psychological distress (GHQ-12 score ≥ 15) was present in 57.2% of nurses. Among demographic and COVID-19-related variables, only educational level was significantly and negatively correlated with mental health. After controlling the variables, hierarchical regression analyses results showed that lower resilience was associated with poor mental health (ß = -0.49; P < 0.001). Conclusion: Regarding the nurses' mental health, appropriate psychological/psychiatric intervention is necessary, and resilience can play a role as a mental health promoter.

Predictors of short-term outcomes of burn in a newly established burn centre in Iran.

AIM: This study aimed to determine the predictors of hospital stay and mortality in patients with burns. DESIGN: This is a cross-sectional, retrospective study. METHODS: This study was performed on 626 medical records in Velayat Subspecialty Burn and Plastic Surgery Center in Rasht, Iran, during 2008-2013. RESULTS: Men comprised 78.4% of the study population. Overall, 50.2% of the participants lived in rural areas, and 72.5% were married. The majority of burns occurred at home (49.5%), and thermal factor (87.4%) was the major cause of burn injuries. Also, 6.9% of the patients died after burns. The mean length of hospital stay was 12.62 ± 13 days. Age (OR = 1.07), total body surface area (TBSA%) (OR = 1.12) and length of ICU stay (OR = 1.06) were the strongest predictors of mortality. Gender (IRR = 0.85), TBSA% (IRR = 1.01), location of burn (IRR = 1.1), skin graft (IRR = 2.12), length of ICU stay (IRR = 1.04), re-hospitalization (IRR = 1.77) and burn degree (IRR = 1.09) were the predictors of the length of hospital stay. CONCLUSION: BSA is still an important predictor of mortality and length of hospital stay, as the most important short-term outcomes of burns.

The effect of adding duloxetine to lansoprazole on symptom and quality of life improvement in patients with gastroesophageal reflux diseases: A randomized double-blind clinical trial.

BACKGROUND: Gastroesophageal reflux disease (GERD) is a common upper gastrointestinal disorder with a negative impact on the quality of life. This study was aimed to assess the effect of adding duloxetine to lansoprazole on the symptom and quality of life improvement in GERD patients. MATERIALS AND METHODS: Seventy adult patients with a complaint of heartburn and regurgitation were enrolled in this randomized trial. Patients with a history of atypical symptoms, advanced systemic disease, medication-induced symptom, structural lesion in endoscopy, allergy to the medication, and unco-operative were excluded. The patients randomly (computer generated table) assigned in Groups A who received lansoprazole 30 mg plus placebo daily and Group B, in which duloxetine 30 mg daily replaced by placebo during 4 weeks. All of participants, care-givers, and outcomes assessors were blinded. Basic demographic data, symptom severity score, depression and anxiety Beck score, and quality of life questionnaire were recorded at the starting and ending of treatment. RESULTS: Fifty-four patients have completed the study. The mean difference of Anxiety Beck score (13, 95% confidence interval [CI] [10-16], P = 0.001) and total raw score of quality of life (7, 95% CI [3.89-10.11], P = 0.043) were significantly improved in Group B. Complete and overall heartburn improvement rates were significantly better in Group B (odds ratio [OR] Adj: 2.01, 95% CI [1.06-2.97] and OR Adj: 1.31, 95% CI [1.05-1.57], respectively). CONCLUSION: We found that the combination of duloxetine and lansoprazole is a safe and tolerable regimen, and it can significantly improve anxiety, heartburn, coffee consumption, the quality of sleep, and life in patients who suffer from the symptoms of GERD.

Bone Mineral Density and Related Factors in Renal Transplant Recipients, in the North of Iran.

INTRODUCTION: Renal transplantation can lead to or be associated with Low bone mineral density (BMD). The aim of this study is evaluation of BMD and related factors in our renal transplant patients. METHODS: In this descriptive cross-sectional analytical study, 148 kidney transplant patients from university hospital, were enrolled. BMD of hip and lumbar spine was measured by dual-energy X-ray absorptiometry (DXA) and patients were divided into 3 groups: normal, osteopenia, and osteoporosis; according to T-score. Laboratory parameters and a series of variables were investigated, and the results were compared with BMD findings. RESULTS: In this study, 73 patients (49.3%) had osteopenia and 28 patients (18.9%) were osteoporotic. BMI was significantly lower in the osteoporosis group compared with the normal group (P < .05). Cumulative dose of prednisolone and calcium supplement were higher in osteoporotic group compared with normal group. CONCLUSION: According to our results, osteoporotic and osteopenia groups have lower BMI that is associated with lower BMD. This can lead to increased risk of bone fractures in the future. Early discontinuation or reduction of prednisolone dose can improve BMD.

Anxiety and depression and the related factors in nurses of Guilan University of Medical Sciences hospitals during COVID-19: A web-based cross-sectional study.

BACKGROUND: The outbreak of COVID-19 is an unprecedented challenge to the health systems in Iran. We aimed to assess the psychological impact of this outbreak on nurses in the hospitals of Guilan University of Medical Sciences that is one of the top provinces of incidence of COVID-19. METHODS: In a web-based cross-sectional study, 441 nurses working were selected from the hospitals, from 7 to 12 April 2020. Anxiety and depression were measured using the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9, respectively. Simple and multiple logistic regression models were used to identify the factors related to anxiety and depression. RESULTS: The majority were in contact with suspected or confirmed COVID-19 cases (93.4%) and their relatives had been infected with COVID-19 (42%). The mean of anxiety-7 and depression total scores were 8.64 ± 5.60 and 8.48 ± 6.19, respectively. Female (OR = 3.27, 95% CI = 1.01-10.64), working in COVID-19 designated hospital (OR = 1.82, 95% CI = 1.13-2.93), being suspected with COVID-19 infection (OR = 2.01, 95% CI = 1.25-3.26), and insufficient personal protective equipment (OR = 2.61, 95% CI = 1.68-4.06) were associated with anxiety. Depression was significantly associated with female sex (OR = 4.62, %95 CI = 1.24-17.16), having chronic disease (OR = 2.12, 95% CI = 1.20-3.74), being suspected or confirmed with COVID-19 infection (OR = 3.44, 95% CI = 2.11-5.59, and OR = 2.21, 95% CI = 1.04-4.70, respectively), and insufficient personal protective equipment (OR = 1.86, 95% CI = 1.19-2.91). CONCLUSION: The finding declares healthcare workers are at high risk for mental illness. Continuous supervision of the psychological consequences following infectious diseases outbreaks should be a part of the preparedness efforts of health care systems.

Social Determinants of Breast Cancer Screening among Married Women: A Cross-Sectional Study.

BACKGROUND: Regular cancer screening is the best way for early detection of breast cancer, but studies showed the low participation rates of screening in Iran. We aimed to determine breast cancer screening among married women and related factors in North of Iran. STUDY DESIGN: A cross-sectional study. METHODS: This cross-sectional study was carried out from Jan to Mar 2017 among 1472 married women in an urban population in Rasht City, North of Iran. Data were collected using a questionnaire included socio-demographic information and breast cancer screening behaviors. Descriptive statistics, chi-square and logistic regression were used for data analyzing with SPSS. RESULTS: The mean age of women was 35.1 ±6.5 years. Majority of women never performed clinical breast examination (70.7%) and regular monthly breast self-examination (52.2%). Only women over 40 yr performed mammography. Mammography performance was associated with health insurance (OR=4.99; 95% CI: 1.10, 22.53) and family history (OR=1.60; 95% CI: 1.19, 2.19), clinical breast examination was associated with age of women (OR=2.87; 95% CI: 1.90, 4.32) and breast self-examination was associated with age and occupation of women [OR=1.67; 95 % CI: 1.16, 2.39, OR=1.65; 95% CI: 1.19, 2.29) respectively]. CONCLUSION: The rate of breast cancer screening was low among married women. Therefore considering the structural and cultural barriers, effective health education is essential to reduce inequality and increase the efficiency of screening programs.

Diabetic foot care: knowledge and practice.

BACKGROUND: Diabetic foot ulcers (DFUs) are common problems in diabetes. One of the most important factors affecting the quality of diabetes care is knowledge and practice. The current study aimed at determining the knowledge and practice of patients with diabetes regarding the prevention and care of DFUs. METHODS: The current analytical, cross sectional study was conducted in Guilan Province (north of Iran) on 375 patients registered in the medical records as type 2 diabetes mellitus. Demographic characteristics, knowledge, and practice of participants were recorded in a questionnaire during face-to-face interviews conducted by the researcher. Descriptive and inferential statistics were performed using SPSS version18. RESULTS: The mean score of knowledge was 8.63 ± 2.5 out of 15, indicating that the majority of participants had a poor knowledge (84.8%). The mean practice score was 7.6 ± 2.5 out of 15, indicating that a half of them had poor performance (49.6%). There was a significant and direct correlation between knowledge and practice. Knowledge level, place of residence, marital status, and history of admission due to diabetic foot were predictors of practice score. CONCLUSIONS: According to the low level of knowledge and practice in patients with diabetes regarding the prevention and care of DFUs, and considering the significant relationship of some demographics of patients with knowledge and practice scores, a targeted educational program is needed to promote knowledge of patients with diabetes.

Comparison between a nurse-led weaning protocol and a weaning protocol based on physician's clinical judgment in ICU patients.

PURPOSE: The purpose of this study was to compare a nurse-led weaning protocol with a physician-driven weaning protocol in mechanically ventilated (MV) patients. METHODS: In this quasi-experimental study with a one-group design, a total of 65 ICU patients, requiring MV for more than 72 h, were selected via convenience sampling. In routine practice, the physician's clinical judgment is needed to determine the patient's readiness for liberation from MV. A physician-driven weaning protocol was compared with a nurse-led protocol, using Burn's Weaning Scale (BWS) in three working phases. Descriptive and inferential statistics were measured for data analysis using SPSS version 16. RESULTS: Based on BWS, the mean MV duration was 111.75±33.46 h in the nurse-led weaning group and 125.12±43.43 h in the physician-driven weaning group. There was a significant difference in terms of MV duration between the two groups (P = 0.000). CONCLUSION: The present findings showed that nurses' assessment of patient's readiness for weaning from MV (BWS) is a safe approach during the day, which can reduce MV duration more than other typical methods in ICUs.

Academic burnout as an educational complication and promotion barrier among undergraduate students: A cross-sectional study.

BACKGROUND: Academic burnout is a worldwide problem that troubles students at all academic levels. Despite the significant effects of this problem on students' mental health and academic achievements, yet, it has not been adequately studied in Iranian system of academic education. Therefore, we aimed to explore the incidence of academic burnout status and its associated factors among the students at Guilan University of Medical Sciences. SUBJECTS AND METHODS: This cross-sectional study was conducted over a number of 303 students at Guilan University of Medical Sciences during 2016. Study samples were selected through the stratified random sampling method, and a set of data including sociodemographic information, educational status, study habits, and burnout inventory status was collected for each sample. Items of burnout inventory status were based on the Maslach Burnout Inventory. Data were analyzed using descriptive and inferential statistics including t-test and linear regression. RESULTS: The students in our study reported a mean of 2.53 ± 0.7 for academic burnout score. Along with related factors of academic burnout, marital status (P = 0.029), grade point average (P = 0.002), being interested in field of study (P = 0.000), and study time (P = 0.000) were significantly associated with academic burnout of students. Furthermore, the incidence of academic burnout did not differ between male and female students. CONCLUSIONS: Regarding the considerable prevalence of academic burnout among students of medical sciences, it is needed that policymakers implement more effective educational programs considering the associated factors of academic burnout.

Unplanned readmission after hospital discharge in burn patients in Iran.

INTRODUCTION: Burns are considered as one of the most serious health problems throughout the world. They may lead to adverse consequences and outcomes. One of these outcomes is unplanned readmission. Unplanned readmission has been commonly used as a quality indicator by hospitals and governments. This study aimed to determine the predictors of unplanned readmission in patients with burns hospitalized in a burn center in the North of Iran (Guilan province, Rasht). METHODS: This retrospective analytic study has been done on the medical records of hospitalized patients with burns in Velayat Sub-Specialty Burn and Plastic Surgery Center, Rasht, Iran during 2008-2013. In general, 703 medical records have been reviewed but statistical analysis was performed on 626 medical records. All data were entered in SPSS (version 16) and analyzed by descriptive and inferential statistics. RESULTS: Among 626 patients with burns, the overall readmission rate was 5.1%. Predictors of readmission included total body surface area (OR 1.030, CI 1.011-1.049), hypertension (OR 2.923, CI 1.089-7.845) and skin graft (OR 7.045, CI 2.718-18.258). CONCLUSION: Considering the outcome, predictors following burn have a crucial role in the allocation of treatment cost for patients with burns and they can be used as one of the quality indicators for health care providers and governments.

Quality assessment of diabetic foot ulcer clinical practice guidelines.

OBJECTIVE: Nurses play an effective role in diabetic foot care and they should know the best evidence. In this way, implementations according evidence-based clinical practice guidelines have positive effects on nurses' practice and patient outcomes. The objective of this study was quality assessment of diabetic foot ulcer clinical practice guidelines. METHODS: Evidence about nursing care in diabetic foot ulcer in last 5 years was searched and categorized based on nursing diagnosis (ND) and evidence levels and was finally designed as a guideline. Quality appraisal of guideline was evaluated with AGREEII tool by an expert panel. AGREEII consists of 23 items, grouped in six domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence. Applicability of the guideline in clinical was assessed with a checklist by the nursing group. Data analysis was carried out with SPSS v.18 (descriptive statistics and binomial test). RESULTS: Of the 114 studies, evidence of 19 studies was selected. The guidelines had three parts: introduction, nursing recommendation, and appendix. Evidence was categorized according to 8 NDs. According to AGREEII, the guideline had the highest score in the "scope and purpose" (92.7%) and the lowest in "applicability" (76.2%) domains. Also, nurses reported the positive effect of implementation of guideline recommendations and lack of needed equipment for its implementation. CONCLUSIONS: Guidelines received acceptable scores in all the domains of AGREEII. Based on nurses' opinion, recommendations of guidelines will play an effective role in prevention, treatment, reduction of complication among diabetic foot patients. Therefore, adaptation, implementation, and evaluation of the guidelines were recommended.

Assessing Emergency Nurses' Clinical Competency: An Exploratory Factor Analysis Study.

BACKGROUND: Nursing as a clinical discipline is developing in the emergency wards. Health care systems should continuously assess and prioritize indicators of clinical competency in these wards. The lack of clear standards of clinical competency indicators challenges evaluation. The purpose of this study was to determine clinical competency indicators and its priority based on nurses' views in educational and therapeutic centers in Guilan. MATERIALS AND METHODS: The Q methodology was conducted in three phases, that is, phase I (determining the clinical competency indicators), phase II (classifying clinical competency indicators by an expert panel), and phase III (prioritizing clinical competency indicators). The subjects were selected by convenience sampling among nurses working in the emergency wards of teaching hospitals affiliated to Guilan in 2013. Finally, clinical competency indicators were prioritized using exploratory factor analysis. RESULTS: In the prioritizing phase, data were collected from 710 nurses over two months. Five factors with 30 general competencies were found in three domains: communication, professional maturity, and personality characteristics. Six factors with 37 specific competencies were also found in two domains: scientific and technical capabilities and basic clinical skills that can provide a structured instrument for assessing clinical competence in emergency nurses. CONCLUSIONS: Achieved competencies can be used as a reference for nursing education and practice in emergency. Further research on health care system is needed in order to achieve a reliable and valid instrument.

Anticyclic citrullinated peptide antibody in rheumatoid arthritis:a cross-sectional study in Iran.

BACKGROUND/AIM: Studies have shown that anticyclic citrullinated peptide antibody (anti-CCP) titers can be useful in the diagnosis of rheumatoid arthritis (RA). We evaluate the association between anti-CCP antibody titers and the demographic, clinical, and laboratory characteristics of RA patients. Moreover, we explore whether there is any relation between joint destruction and demographic and clinical characteristics of RA patients. MATERIALS AND METHODS: One hundred and four RA patients with positive anti-CCP titers were compared to 104 RA patients with negative anti-CCP titers. The activity of RA was evaluated using the Disease Activity Score 28 (DAS28). Joint destruction was assessed in the subjects by X-rays of the wrists. Blood samples were collected for assessment of anti-CCP, rheumatoid factor (RF), and erythrocyte sedimentation rate. RESULTS: Forty-eight (23.0%) males and 160 (76.9%) females were included in this study. RF, DAS28, and joint destruction were significantly different between patients with and without anti-CCP (P < 0.0001). DAS28, duration of disease, hospitalizations, and occupation differed significantly between patients with and without joint destruction (P < 0.0001). CONCLUSION: This study indicates that anti-CCP is correlated with a high disease activity index and more joint destruction in RA patients and it may be used as a prognostic factor for RA.