The effects of family-centered affective stimulation on brain-injured comatose patients' level of consciousness: A randomized controlled trial.

BACKGROUND: Despite the well-defined effects of sensory stimulation, the knowledge of the pure effects of affective stimulation is scarce. OBJECTIVE: To evaluate the effects of family-centered affective stimulation on the level of consciousness among comatose patients with brain injuries. DESIGN: This study was designed as a three-group double-blinded Randomized Controlled Trial. METHODS: Ninety consecutive patients with traumatic brain injuries and a Glasgow Coma Scale score of 5-8 were selected. Patients were randomly allocated to an experimental, a placebo, and a control group using permuted block randomization. Affective stimulation intervention was provided to patients in the experimental group by their family members twice a day during the first seven days of their hospitalization. In the placebo group, a sensory stimulation program was implemented by a fixed trained person who was not familiar with the patients. Patients in the control group solely received sensory stimulation which was routinely provided to all patients. The level of consciousness among the patients using the Glasgow Coma Scale and Coma Recovery Scale-Revised were measured both before and after a family visit. The SPSS software (version 17.0) was used to analyze the data through running the one-way and the repeated measure analyses of variance. RESULTS: Despite an insignificant difference among the groups regarding baseline level of consciousness, the results of the one-way analysis of variance revealed at the seventh day of this study, however, the level of consciousness in the experimental group was significantly higher (9.1±2.1) than the placebo (7.2±1.1), the control groups (6.6±1.7) (P<0.001), subsequently. Moreover, at the seventh day of the study, the Coma Recovery Scale score in the experimental group (11.9±3.7) was significantly greater than the placebo (9.0±2.0) and the control (6.6±1.6) groups (P<0.001). Recovery rate and effect size values also confirmed the greater effectiveness of affective stimulation compared with pure sensory stimulation. CONCLUSION: Our findings in this study indicate that early family-centered affective stimulation is more effective than sensory stimulation in improving the level of consciousness among comatose patients with brain injuries. Family-centered affective stimulation is recommended to be integrated into the nursing curricula and routine care plans for comatose trauma patients in intensive care units.

Investigating the effective factors in creatinine changes among hemodialysis patients using the linear random effects model.

Background and objectives:Out of 10 apparently healthy humans, one was somewhat suffering from one of the types of renal disease. Hemodialysis is known as the most applicable method of taking care of this group of patients. In addition, serum creatinine is an important mark in the performance of kidneys. The aim of the present study was to investigate the effective factors in creatinine and its effect on the performance of kidneys. Materials and methods: The present study is a longitudinal experiment in which 500 participants were randomly selected from the hemodialysis patients in Mazandaran Province. Creatinine variable was considered as the longitudinal responding variable, which was measured 3 times per year over a period of 6 years. The random effects model was also considered the most appropriate model for the collected data. Results:The total mean value of creatinine was 1.62 ± 0.49, among men 1.69 ± 0.46 and among women 35.1 ± 0.49. Variables of weight (p<0.001), age of disease diagnosis (p<0.001), time (p<0.001), gender (p<0.005), and cardiovascular diseases were significant and had effects on the trend of creatinine changes among the hemodialysis patients. Creatinine mean value had an increasing trend. Conclusion:Blood creatinine had a significant effect on the performance of kidneys, and the identification of variables that affected the creatinine level was highly helpful in controlling the performance of the kidneys. The results of most studies conducted on hemodialysis patients indicated that by measuring and controlling variables like weight, tobacco consumption, and control of related diseases like blood pressure could predict and control creatinine changes precisely.

Predictive value of plasma haematocrit level in early diagnosis of pre-eclampsia.

While pre-eclampsia is the most common complication of pregnancy, a definitive screening test for early diagnosis is still elusive. In this study, haematocrit value was assessed as a screening test for pre-eclampsia in 660 women at 24-28 weeks of pregnancy attending a hospital in Tehran, Islamic Republic of Iran. Mean haematocrit values were significantly higher in pre-eclamptic than non-pre-eclamptic women: 37.7% (SD 2.0%) and 35.9% (SD 1.7%) respectively. The receiver operating characteristics curve showed that the most appropriate cut-off point for the haematocrit test in this sample of women was 38%; at this value the sensitivity was 58.6% and specificity was 88.9%; positive and negative predictive values were 33.7% and 95.7% respectively. The haematocrit, done as a routine screening test for anaemia at 24-28 weeks of pregnancy, may also be useful as a screening test for early diagnosis of pre-eclampsia.

Predictive value of plasma haematocrit level in early diagnosis of pre-eclampsia

While pre-eclampsia is the most common complication of pregnancy, a definitive screening test for early diagnosis is still elusive. In this study, haematocrit value was assessed as a screening test for pre-eclampsia in 660 women at 24-28 weeks of pregnancy attending a hospital in Tehran, Islamic Republic of Iran. Mean haematocrit values were significantly higher in pre-eclamptic than non-pre-eclamptic women; 37.7% [SD 2.0%] and 35.9% [SD 1.7%] respectively. The receiver operating characteristics curve showed that the most appropriate cut-off point for the haematocrit test in this sample of women was 38%; at this value the sensitivity was 58.6% and specificity was 88.9%; positive and negative predictive values were 33.7% and 95.7% respectively. The haematocrit, done as a routine screening test for anaemia at 24-28 weeks of pregnancy, may also be useful as a screening test for early diagnosis of pre-eclampsia

Self-efficacy: does it predict the effectiveness of contraceptive use in Iranian women?

This study explored the relative effects of self-efficacy on oral contraceptive use among a sample of 352 Iranian married women aged 18-49 years. In structured interviews 5 variables based on the Steps to Behaviour Change model (knowledge, approval, intention, practice and advocacy) were assessed and correlated with measures of family planning self-efficacy and general self-efficacy. The results indicated that the 2 independent measures, when taken together, were more effective in predicting behavioural intentions for effective use of oral contraceptives, with family planning self-efficacy making the strongest contribution. It is suggested that self-efficacy intervention techniques will benefit oral contraceptive users in preventing unintended pregnancies.

Self-efficacy: does it predict the effectiveness of contraceptive use in Iranian women?

This study explored the relative effects of self-efficacy on oral contraceptive use among a sample of 352 Iranian married women aged 18-49 years. In structured interviews 5 variables based on the Steps to Behaviour Change model [knowledge, approval, intention, practice and advocacy] were assessed and correlated with measures of family planning self-efficacy and general self-efficacy. The results indicated that the 2 independent measures, when taken together, were more effective in predicting behavioural intentions for effective use of oral contraceptives, with family planning self-efficacy making the strongest contribution. It is suggested that self-efficacy intervention techniques will benefit oral contraceptive users in preventing unintended pregnancies