Comparison of the Effect of Education Using Team-based Learning Method and Lecture Method on Controlling Diabetes in the Elderly: A Quasi-Experimental Study.

Background: Patient education is considered as an essential part of diabetes control. This research is conducted to compare the effect of education using team-based learning (TBL) method and lecture method on blood pressure (BP), serum levels of fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c), and Body mass index (BMI) in the elderly with diabetes. Methods: This quasi-experimental study was conducted on 61 elderly patients with type 2 diabetes in diabetes clinics in Rafsanjan, during October 2018 to January 2019. Patients were selected using simple random sampling. They were divided into two groups of TBL and lecture-based learning. For each group, educational content was presented through 2-hour sessions held once a week for 1 months. FBS, HbA1c, BMI, and BP were measured at baseline and 3 months after the intervention. Data were analyzed through SPSS 21, using Chi-square test, independent t-test, and paired t-test; A P-value<0.05 was considered as significant. Results: After the intervention, the TBL group had a significant decrease in systolic and diastolic BP compared to the lecture group (P<0.001). Before and 3 months after the intervention in the TBL group, there was a significant decrease between the means of FBS (P=0.01), HbA1c (P<0.001), and systolic and diastolic BP (P<0.001), but in the lecture group, only the systolic BP showed a significant decrease (P<0.001). Conclusion: TBL method had more effects on controlling diabetes type 2 in the elderly than the lecture method. It is suggested that health providers should consider TBL for the education of the elderly with diabetes.

Analgesic Effect of Preoperative Intravenous Administration of Paracetamol on Post-cesarean Pain: A Randomized Clinical Trial.

Background: Pain control after every surgery, especially cesarean section, is very important, and physicians strive to discover pain control methods using the least amount of opioids. Paracetamol is a non-opioid analgesic with few complications. Objectives: The present study aimed to investigate the analgesic effect of preoperative intravenous administration of paracetamol on post-cesarean pain. Methods: This randomized, double-blind clinical trial was conducted on 240 pregnant women under spinal anesthesia who were candidates for elective cesarean section. The patients' weight, height, age, and body mass index (BMI) were recorded, and patients were randomly divided into 2 equal groups (n = 120). In the first group, 10 mg/kg paracetamol in 100 mL of normal saline (paracetamol group) and, in the second group, 100 mL normal saline (control group) were administered 15 minutes before surgery intravenously. Blood pressure, pulse rate, chills, and nausea were recorded during and 1 hour after surgery; in addition, the visual analogue scale (VAS) and the need for additional analgesics were recorded 1, 2, 4, 6, 12, and 24 hours after surgery. Results: Mean pain scores were significantly lower in the paracetamol group (4.01 ± 2.22) than in the control group 6 hours (4.83 ± 2.35; P = 0.008) and 24 hours (2.26 ± 1.85 and 2.67 ± 1.80, respectably; P = 0.038) after surgery. Mean meperidine consumption was lower in the paracetamol group than in the control group, but it was not significant. No significant difference was found between the 2 groups in the frequency of chills and nausea (P > 0.05). Conclusions: Within the limitations of the current study, preoperative intravenous administration of paracetamol significantly reduced post-cesarean pain within 24 hours.

Comparative Study of the Effect of Acupressure and Abdominal Massage on Constipation in Elderly Women: A Clinical Trial Study.

Constipation is a common complaint and challenge in the elderly. Methods such as acupressure and abdominal massage can be considered for the treatment of constipation in the elderly. This study aimed to compare the effect of abdominal massage and acupressure on constipation in healthy elderly women. In this study, 60 elderly women with constipation participated in two groups. The first group underwent acupressure for 3 minutes every day for 5 days, and the other group underwent classical abdominal massage for 15-20 minutes every day for 5 days. The two groups were followed for a month. Data collection tools included a demographic characteristics questionnaire, Rome III criteria, and constipation assessment scale. The data were analyzed by SPSS18 software. Following the intervention, there was no significant difference between the two groups (p > .05). But in the first month, the mean scores of constipation in the abdominal massage and acupressure groups were 6.30 ± 3.47 and 9.03 ± 3.84, respectively, which showed a significant difference between the two groups for that time period (p = .005). Although there was no significant difference between the two methods during the intervention, the severity of constipation did decrease in each group. Also, in the first month after individual intervention, a significant difference was observed between the two groups. We conclude that abdominal massage can be suggested as an applicable and simple method in the treatment of constipation for elderly women.

Comparison of The Effects of Cognitive Therapy and Logotherapy on Iranian Elderly People's General Health.

BACKGROUND: Mental health promotion programs in the elderly are important. The main objective of the present study was to compare the effects of cognitive therapy and logotherapy on the general health of elderly people who referred to health centers. METHODS: This is a quasi-experimental study with pretest-posttest design using a control group. A sample of 90 elderly people was recruited from health centers located in Rafsanjan, between April 2017 and June 2017. 30 participants were considered in each group, separately (cognitive therapy (N=30), logotherapy (N=30), and control (N=30)). Cognitive therapy and logotherapy programs were implemented in eight 90-minute sessions, while people in the control group received neither cognitive therapy nor logotherapy. The demographic questionnaire was used at baseline. The 28-item General Health Questionnaire (GHQ-28) was used in two steps of pre-test and post-test. The study data were analyzed through independent t-test, Chi-square, one-way ANOVA, and the Tukey's post hoc tests; SPSS 18 was used to analyze the data, and P<0.05 was considered as significant. RESULTS: The mean GHQ-28 total scores before the intervention in the cognitive therapy and logotherapy groups and control group were 52.53±2.55, 52.63±5.64, and 52.26±4.09, respectively, which were not significantly different (P=0.94). However, after the intervention these scores were 41.60±3.31, 40.46±3.97 and 51.93±4.22, respectively, and the difference between the two intervention groups and control group was statistically significant (P<0.001). There was no significant difference between the two intervention groups (P=0.49). CONCLUSIONS: Group cognitive therapy is as effective as logotherapy in improving the elderly people's general health.

The effect of Pilates exercise on the happiness and depression of elderly women: a clinical trial study.

BACKGROUND: The available approaches for reducing mental problems, particularly for elderlies, include physical activities and exercise. Pilates is a sport that has received much attention during the past few years. The present study was conducted to explore the influence of Pilates on depression and happiness levels of elderly women. METHODS: This randomized trial work was conducted on 60 elderly women referred to the health center of Rafsanjan city, southern Iran. The participants were randomly assigned into two intervention (Pilates) and control groups, each with 30 members. In the intervention group, participants did Pilates three sessions each week for 8 weeks. The control group did not receive any intervention similar to the intervention group. The happiness level of the participants was measured using the Oxford Happiness Inventory (OHI) and their depression was measured using the Beck Depression Inventory (BDI) before, one month after, and two months after the intervention. A mixed ANOVA was applied for data analysis. RESULTS: The majority of the participants were married housewives with primary education and age range of above 62 years. Based on the findings of this study, the mean happiness and depression scores of the participants at the end of months one and two in the intervention groups increased significantly compared to those of the control group. CONCLUSIONS: Doing Pilates for 8 weeks may positively affect the depression and happiness levels of the elderly. Thus, it is recommended as a healthy exercise for elderlies.

Effects of a Comprehensive Care Program on the Readmission Rate and Adherence to Treatment in Elderly Patients with Chronic Obstructive Pulmonary Disease.

BACKGROUND: The low treatment adherence of patients with chronic obstructive pulmonary disease (COPD) leads to the exacerbation of their symptoms and readmission. Comprehensive care programs are among interventions that can improve the patients' adherence to treatment and prevent readmission. The present study aimed to evaluate the effects of a comprehensive care program on the adherence to treatment and readmission of COPD patients. MATERIALS AND METHODS: This randomized clinical trial was performed in a hospital in Rafsanjan, Iran, in 2017. Sixty elderly patients with COPD were randomly enrolled in this study by pair-matching. The intervention group participated in a comprehensive care program, whereas the control group received routine care. The readmission rate and adherence to treatment were measured at one-, three-, and six-month intervals. To evaluate the patients' adherence to treatment, an adherence-to-treatment questionnaire for chronic diseases was used. Data were analyzed using Chi-square test, independent t-test, and repeated measures ANOVA at a significance level of 0.05. RESULTS: A significant difference was observed between the two groups in terms of readmission at the end of the study (P=0.03). In the intervention group, the mean level of adherence to treatment and its subscales improved as compared to the control group, and there was a significant difference between the two groups. CONCLUSION: Although most of the patients in this study were old, with a rather low educational level and socioeconomic status, the care program could improve their treatment adherence and reduce the readmission rate.

The Association between Risk Factors and Prodromal Myocardial Infarction Symptoms: A Cross-Sectional Study in Iran.

BACKGROUND: Prodromal symptoms in individuals with risk factors remain challenging, even though myocardial infarction has been noted in research. This study determined the association of risk factors with patients' baseline myocardial infarction related prodromal symptoms. METHODS: In a cross-sectional study, 154 Iranian men and women, mean age 59.62 ± 12.74 years were assessed in 2016-2017. The frequency besides severity of 33 prodromal symptoms and risk factors was assessed using McSweeney Prodromal Myocardial Infarction Symptom Survey. RESULTS: The main cardiac prodromal symptoms experienced by patients were chest pain/discomfort (n = 99, 64.30%), unusual fatigue (n = 78, 50.60%), and sleep disturbance (n = 33, 20.40%). Women experienced more prodromal symptoms than men (33.26 ± 21.88 vs. 25.48 ± 17.75). Among risk factors, only sex was associated with prodromal symptoms score (P < 0.05). CONCLUSION: The frequently experienced prodromal symptoms, i.e., before MI were chest pain/discomfort, unusual fatigue, and sleep disturbance. A crucial finding was the significant association between sex and prodromal symptoms. Identifying prodromal symptoms in patients with risk factors can prevent the incidence of myocardial infarction.

IL-17A and IL-23: plausible risk factors to induce age-associated inflammation in Alzheimer's disease.

Background: Aging and its complications such as Alzheimer's disease (AD) are associated with chronic low-grade inflammation entitled age-associated inflammation. However, the main mechanisms whichinduce age-associated inflammation in aging and AD are yet to beclarified. L-23/IL-17A axis plays important roles in the induction of inflammation and consequently autoimmune disease. This review evaluates the main roles played by IL-17A, IL-23, and IL-17A/IL-23 axis in the pathogenesis of age-associated inflammation in AD patients. Result: IL-23/IL-17A axis, is an important factor participate in the pathogenesis of age-associated inflammation. The genetic variations and microbial infection can be considered as the most important candidates to induce AD via upregulation of IL-17A. IL-17A also deteriorates AD via induction by amyloid-ß. IL-17A participates in the induction of AD by increasing neutrophils infiltration to brain, induction of neuroinflammation, increase in FASL, and amyloid-ßdeposition as well as activation of microglia. Conclusions: Due to the important roles played by IL-23/IL-17A axis in AD pathogenesis, it can be considered as a target for immunotherapy against AD. Abbreviations: Aß: ß-Amyloid; AD: Alzheimer's disease; CD: cluster of differentiation; DAMPs: Damage-associated molecular patterns; DCs: dendritic cells; HLA: human leukocyte antigen; NF-κB: nuclear factor kappa-light-chain-enhancer of activated B cells; RAR: retinoic-acid receptor; RORγt: RAR-related orphan receptor gamma t; SAMP8: senescence-accelerated mouse prone 8 strain; TGF-ß: tumor growth factor-ß; TLRs: toll-like receptors.

The Impact of Spiritual Care Education on the Self-Efficacy of the Family Caregivers of Elderly People with Alzheimer's Disease.

BACKGROUND: Caring for people who suffer from Alzheimer's disease is stressful. Family caregivers of these people usually experience physical and mental burnout and lose their efficacy in doing care-related activities. The present study aimed to examine the impacts of spiritual care education on self-efficacy of the family caregivers of people with Alzheimer's disease. METHODS: This study was conducted from October to December 2015 by using a two-group pretest-posttest quasi-experimental design. In total, 60 family caregivers of people with Alzheimer's disease were recruited and randomly allocated to the intervention and control groups. A spiritual care educational intervention was implemented for the caregivers in the intervention group. The data were collected before and three weeks after the study intervention by using the ten-item General Self Efficacy scale. The study data were analyzed in SPSS using Chi-square and independent t-test. RESULTS: Before the study intervention, the means of pretest self-efficacy scores in the intervention and control groups were 29.80±4.80 and 28.39±6.41, respectively. There was no significant difference between the groups regarding the mean score of self-efficacy (P=0.36). After the study, these two scores changed to 32.73±4.75 and 27.85±5.98, respectively. However, after the intervention, the mean score of self-efficacy in the intervention group was significantly higher than the control group (P=0.002). CONCLUSION: Spiritual care can enhance the self-efficacy of the family caregivers of people who suffer from Alzheimer's disease. Therefore, care providers are recommended to use such spirituality-based interventions for empowering family caregivers.

Effects of technology on nursing care and caring attributes of a sample of Iranian critical care nurses.

PURPOSE: To examine the association between attitudes of critical care nurses about influences of technology and their caring attributes. STUDY DESIGN AND METHODOLOGY: In a cross-sectional study, firstly the psychometric properties of caring attributes questionnaire, which was developed to examine caring attributes of a sample of international nurses, was refined in a sample of 200 critical care nurses working in educational hospitals of a city in the southwest of Iran. Results of factor analysis with Varimax rotation decreased 60 items of caring attributes to 47 items which loaded under five subscales of caring negation, caring compassionate, caring advocacy, caring essence and caring communication. Secondly, attitudes of these nurses toward influences of technology on nursing care were assessed using a 22-item questionnaire, developed by the study researchers. Finally, the association between scores of caring attributes and attitudes toward influences of technology of this sample was determined. RESULTS: There was a positive association between caring attributes and influences of technology among our study nurses. Caring attributes scores were higher in female single nurses. Although caring attributes' scores had decreased along with age and work experience, caring commitment was higher in older more experienced nurses. Furthermore, female nurses had a better attitude toward influences of technology on their care. In contrast, younger and less experienced nurses had negative views on the effects of technology on nursing care. CONCLUSION: Continuing education and life-long learning on application of new technological equipment in nursing care and harmonising their use with caring values are necessary for nursing students and registered nurses to ensure delivering a patient-centred care, in a technologically driven environment.

Chronoinflammaging in Alzheimer; A systematic review on the roles of toll like receptor 2.

Aging is associated with a range of chronic low-grade inflammation (Chronoinflammaging) which may play a significant role in some chronic inflammatory based diseases, such as Alzheimer disease (AD). However, the events which lead to the induction of chronoinflammaging in AD are yet to be clarified. It has been proposed that the recognition of endogenous ligands by pathogen recognition receptors (PRRs) may be involved in the induction of chronoinflammaging. Toll like receptors (TLRs) are a family of PRRs which recognize endogenous damage associated molecular patterns (DAMPs) and subsequently induce inflammation. Therefore, TLRs are worthy of investigation to elucidate their roles in chronoinflammaging associated AD. This review article explores the main roles played by TLR2 in the pathogenesis of chronoinflammaging in patients suffering from AD.

Vitamin B12 in Association with Antipsychotic Drugs Can Modulate the Expression of Pro-/Anti-Inflammatory Cytokines in Alzheimer Disease Patients.

INTRODUCTION: Patients with Alzheimer disease (AD) suffer from psychotic symptoms including pain. The current antipsychotic drugs confer limited effectiveness, and hence new strategies are being designed to decrease pain in order to increase antipsychological effectiveness. Vitamin B12 is a safe supplementary drug to decrease pain. Additionally, cytokines participate in the pathogenesis of immune-related diseases such as AD. Thus, the main aim of this clinical trial study was to determine the effects of treatment with risperidone and quetiapine, as antipsychotic drugs, with and without vitamin B12 on the psychotic symptoms of AD patients and the expression of IL-6, IL-8, tumor growth factor (TGF)-ß, tumor necrosis factor (TNF)-α, and endothelin (ET)-1). MATERIAL AND METHODS: Serum levels of IL-6, IL-8, TGF-ß, TNF-α, and ET-1 were evaluated in the following groups: healthy controls, nonpsychotic AD patients, psychotic AD patients, psychotic AD patients under treatment with risperidone, psychotic AD patients under treatment with risperidone plus vitamin B12, psychotic AD patients under treatment with quetiapine, and psychotic AD patients under treatment with quetiapine plus vitamin B12. RESULTS: Treatment with antipsychotic drugs plus vitamin B12 led to a decreased expression of IL-8 and TNF-α and an increased expression of TGF-ß. Vitamin B12 in association with quetiapine reduced the pain in psychotic AD patients. DISCUSSION: Proinflammatory cytokines play important roles in the pathogenesis of psychosis in AD patients. Antipsychotic drugs plus vitamin B12 can reduce and induce the expression of proinflammatory and anti-inflammatory cytokines to improve psychotic symptoms in AD patients.

The Burden of Care: Mothers' Experiences of Children with Congenital Heart Disease.

BACKGROUND: Mothers play a key role in caring for their sick children. Their experiences of care were influenced by culture, rules, and the system of health and care services. There are few studies on maternal care of children with congenital heart disease. Also, each of them has studied a particular aspect of care. The present research aimed to understand care experiences of mothers of children with congenital heart disease. METHODS: A conventional content analysis was used to obtain rich data. The goal of content analysis is "to provide knowledge and deeper understanding of the phenomenon under the study". The study was conducted in Kerman, Iran in 2014, on mothers of children with CHD. The purposive sampling technique was used to select the participants. Participants were 14 mothers of children with CHD and one father and one nurse of open heart surgery unit, from two hospitals affiliated with Kerman University of Medical Sciences. Eighteen semi-structured interviews were constructed. Data were analyzed using conventional content analysis. MAXQDA 2007 software (VERBI GmbH, Berlin, Germany) was used to classify and manage the coding. Constant comparative method was done for data analysis. The reliability and validity of the findings, including the credibility, confirm ability, dependability, and transferability, were assessed. RESULTS: According to the content analysis, the main theme was the catastrophic burden of child care on mothers that included three categories: 1) the tension resulting from the disease, 2) involvement with internal thoughts, and 3) difficulties of care process. CONCLUSION: The results of this study may help health care professionals to provide supportive and educational packages to the patients, mothers and Family members until improving the management of patient's care.

Evaluation Indexes of Military Hospitals From the Experts' Perspective: A Qualitative Study.

Given the importance of evaluation in an organization and considering the objectives and missions of military hospitals, we aimed to extract some indexes (in addition to common evaluation indexes) for use in evaluating military hospitals. This was an applied-type qualitative study. The participants were 15 health experts who were first chosen by a purposeful sampling, which was then continued by theoretical sampling. The data obtained were analyzed by using MAXQDA11 software and the content analysis method. After 290 obtained codes were analyzed, 17 indexes in 6 domains were extracted, including capacity development for crisis periods, equipment and facilities, training and research, passive defense, treatment, and services, from which 8 indexes were related to capacity development for crisis periods and equipment and facilities (4 indexes each), 3 indexes were related to services, and 6 indexes were related to training and research, passive defense, and treatment (2 indexes each). The results of the present research, as a supplement to current evaluation methods such as accreditation, can be used for the comprehensive evaluation of military hospitals.

Mutations within the HBc gene of the hepatitis B virus: a study on Iranian patients.

BACKGROUND: Hepatitis B virus (HBV) is a serious risk factor for several severe liver diseases such as cirrhosis and hepatocellular carcinoma. HBV, like other viruses, uses several mechanisms to escape from specific immune responses including the use of mutations in the genome which lead to epitope variations. There are several immune responses, including T helper cells, cytotoxic T lymphocytes, and B cells, against the core antigen of HBV (HBcAg) that can lead to HBV eradication. Therefore, mutations within the HBc gene can lead to escape from immune responses by HBV and, hence, understanding the prevalence of HBc mutations among a specific population can be helpful for future treatment and vaccination. This review addresses the recent information regarding the prevalence of mutations within the HBc gene among Iranian HBV infected patients. METHODS: The data presented here was collected gene sequences reported from Iran to the NCBI nucleotide Gen Bank. RESULTS: Results showed that the prevalence of HBc gene mutations is frequent in Iranian HBV infected patients. CONCLUSIONS: Based on our searches it seems that escape from immune responses is a plausible reason for the high prevalence of HBc gene mutations among Iranian HBV infected patients.

Work values and job satisfaction: a qualitative study of Iranian nurses.

This study aimed to describe the effect of nursing profession work-related values on job satisfaction among a sample of Iranian nurses. We used in-depth interviews with 30 nurses who worked in university-affiliated and public hospitals in Tehran, Iran. The results of thematic analysis of interviews are reported in four themes to present the participants' articulations in linking their work-related values to job satisfaction. The themes consist of values that "encourage tolerance," "enhance inner harmony," "reflect traditional commitment," "enhance unity," and are "centered around altruism and spiritual values." The most satisfied participants considered nursing a divine profession and a tool by which they could gain spiritual pleasure and satisfaction. Our findings highlight the potential role of nursing work-related values in reducing dissatisfaction with one's job. For the nursing profession, this may have implications in reducing job instability and turnover.

Nursing students' time management, reducing stress and gaining satisfaction: a grounded theory study.

In the course of their studies, nursing students must learn many skills and acquire the knowledge required for their future profession. This study investigates how Iranian nursing students manage their time according to the circumstances and obstacles of their academic field. Research was conducted using the grounded theory method. Twenty-one nursing students were purposefully chosen as participants. Data was collected through semi-structured interviews and analyzed using the method suggested by Corbin and Strauss. One of the three processes that the nursing students used was "unidirectional time management." This pattern consists of accepting the nursing field, overcoming uncertainty, assessing conditions, feeling stress, and trying to reduce stress and create satisfaction. It was found that students allotted most of their time to academic tasks in an attempt to overcome their stress. The findings of this study indicate the need for these students to have time for the extra-curricular activities and responsibilities that are appropriate to their age.