Factors Affecting Empathy with Patient among Healthcare Provider Students: A Structural Equation Modeling Study.

CONTEXT: In medicine and health care, empathy is a very important component of relationship between a physician or healthcare provider and patients. AIMS: This study was designed to investigate the factors affecting empathy with patient among healthcare provider students using structural equation model. SETTINGS AND DESIGN: Cross-sectional study. MATERIALS AND METHODS: It was a cross-sectional study to examine the conceptual model based on JSE-HPS. Three hundred ninety-eight students of School of Nursing and Midwifery, Mashhad University of Medical Sciences, Iran participated in the study. They were selected by quota-stratified sampling. The data were collected by JSE-HPS. STATISTICAL ANALYSIS USED: To examine the conceptual model, and SEM was used for ordinal data using WLSMV in Mplus 6. RESULTS: Findings indicated proper model fit so that "perspective-taking" had a positive effect on "compassionate care". "Compassionate care" had a positive effect on "standing in patient's shoes". CONCLUSION: The results of this study can improve students' empathic relationships with patients. The "perspective-taking", "compassionate care" and "standing in patient's shoes" must be emphasized in training programs for medical students providing healthcare in order to familiarize them with the importance of empathy and its role in care. KEY MESSAGES: Empathy is truly the heart of the relationship, Perspective-Taking, Compassionate Care, and Standing in Patient's Shoes can be taken into account to improve the empathy and establish empathic relationships with patients. Proper environment is expected for improving the disease consequences by establishing empathic relationships. HOW TO CITE THIS ARTICLE: Karimi FZ, Abdollahi M. Factors Affecting Empathy with Patient among Healthcare Provider Students: A Structural Equation Modeling Study. Indian J Crit Care Med 2019;23(9):396-399.

Colorectal cancer literacy and related factors in northeast of Iran: A cross-sectional study.

BACKGROUND: Colorectal cancer (CRC) is a health challenge and the second most common cancer worldwide. Increasing colorectal cancer literacy (CRCL) is one of the most effective factors in CRC prevention. AIM: The aim of this study was to determine and evaluate CRCL and its related factors in Torbat Heydarieh, northeastern Iran. METHODS AND RESULTS: This study was a cross-sectional survey conducted in 2021 in Torbat Heydarieh, a city in northeastern Iran, on 200 clients presenting to a comprehensive health service centers. In addition to collecting sociodemographic characteristics, participants were administered the Knowledge and Attitude Questionnaire and the Colorectal Cancer Literacy Questionnaire (CRCLQ). Data were analyzed with SPSS software version 25 using independent samples t-tests, one-way analysis, chi-square, and Pearson correlation coefficients. The statistical significance level was set at p < .05. The results showed that the mean age of the participants was 51.12 ± 8.45 years. The majority of participants (84%) stated that their friends and relatives had no history of CRC. Pearson correlation coefficient results showed a significant correlation between knowledge and attitude toward CRC (r = .15, p = .041). A significant correlation was also found between knowledge and CRCL (r = .4, p ≤ .001). CONCLUSION: We found low CRCL among clients of comprehensive health service centers. More targeted educational interventions are needed to promote CRCL among Iranian adults.

Investigating the Effect of Supportive Interventions on Initiation of Breastfeeding, Exclusive Breastfeeding, and Continuation of Breastfeeding in Adolescent Mothers: A Systematic Review and Meta-Analysis.

Introduction: The initiation of breastfeeding, exclusive breastfeeding, and its duration for 2 years in adolescent mothers is less than adult mothers. The purpose of this study is to determine the effect of supportive interventions on the initiation of breastfeeding, exclusive breastfeeding, and continuation of breastfeeding in adolescent mothers. Methods: Web of Science, PubMed, Scopus, Cochrane Library, EMBASE, ProQuest, SID, Iranmedex, and Google Scholar were searched to find English and Persian clinical trial studies without time limit. The Cochrane checklist was used to check the bias of the articles. Data analysis was done using STATA version 11. I-squared index was used to check the heterogeneity, and funnel plot and Begg test were used to examine the publication bias. The combined odds ratio (OR) and random effects model were used to combine the studies and perform meta-analysis. Results: Of 492 articles, 11 articles were entered to the systematic review. Of 11 articles, three articles were entered to the meta-analysis. The supportive interventions included educational and counseling interventions, home visit, and peer support. The results of the present random effects meta-analysis model showed that the combined OR was 3.38 with 95% confidence interval (1.66-6.88, p = 0.001), thus that, breastfeeding initiation in the intervention group was higher than the control group. Conclusion: Supportive interventions such as educational and counseling interventions, home visits, and peer support are suitable strategies to promote breastfeeding in adolescent mothers. Therefore, it is suggested to integrate these strategies in prenatal and postpartum care of adolescent mothers.

Impact of Self-Efficacy Strategies Education on Self-Care Behaviors among Heart Failure Patients.

Background: Self-efficacy in self-care behaviors is an effective framework for measuring patients' degree of ability to perform self-care behaviors that significantly affect their recovery process and quality of life. This study was designed to investigate the effects of education based on self-efficacy strategies on self-care behaviors in heart failure patients. Methods: A semi-experimental study was conducted on 80 heart failure patients divided into 2 equal groups of test and control. The intervention group received three 60-minute practical and theoretical training sessions based on self-care and self-efficacy strategies, while the control group received the usual care services. Self-care behaviors and self-efficacy were evaluated before training, shortly after training, and 3 months after the training program using the Sullivan self-efficacy questionnaire for heart failure patients and the European self-care behaviors questionnaires. Results: The mean age of the patients was 55.00±8.48 and 51.61±8.51 years in the intervention and control groups, respectively. Women comprised 73.7% (n=59) of the study population. The mean score for the self-care and self-efficacy questionnaires in the experimental group was 23.50±6.58 and 18.57±6.64, correspondingly, before the intervention, which increased to 42.64±6.74 (P<0.014) and 32.29±7.06 (P<0.001), respectively, shortly after the intervention. A significant improvement also occurred at 3 months' follow-up (P<0.001). Self-care behaviors also revealed a positive correlation with self-efficacy shortly after the intervention (r=0.82, P<0.001) and 3 months after the intervention (r=0.85, P<0.001). Conclusion: The implementation of educational interventions based on self-efficacy strategies could have positive effects on health-promoting behaviors among heart failure patients.

A new method of "student-centered formative assessment" and improving students' performance: An effort in the health promotion of community.

BACKGROUND: Improving the learning process in education will empower medical students, and also formative assessment helps improve the teaching-learning process by providing ongoing reflective information about learning gaps. OBJECTIVE: The aim of this study was to explore the effect of student-centered formative assessment by weekly reflective self-correction quizzes on medical laboratory students' performance on the final examination of hematology course in 2018. MATERIALS AND METHODS: A semi-experimental study was conducted on fifty students divided randomly into intervention (n = 25) and control groups (n = 25) using convenience sampling in 2018 from Torbat Heydariyeh University of Medical Sciences, Iran. Data analysis was performed using SPSS software version 16, two-sample t-test, Chi-square test, and analysis of covariance. RESULTS: The intervention had positive effects on students' mean test scores in hematology II so that the intervention and control groups managed to obtain 18.45 ± 1.46 and 14.57 ± 2.64, respectively (P < 0.01). CONCLUSIONS: The results suggested that weekly formative assessments along with reflective self-correction activity and active participation of students in the learning process by designing questions could improve student learning.

Surveying the factor structure and reliability of the Persian version of the Jefferson Scale of Physician Lifelong Learning (JeffSPLL) in staff of medical sciences.

BACKGROUND: In medical sciences, commitment to lifelong learning has been expressed as an important element. Today, due to the rapid development of medical information and technology, lifelong learning is critical for safe medical care and development in medical research. JeffSPLL is one of the scales for measuring lifelong learning among the staff of medical sciences that has never been used in Iran. OBJECTIVES: The aim of the present study was to determine the factor structure and reliability of the Persian version of JeffSPLL among Persian-speaking staff of universities of medical sciences in Iran. METHODS: This study was a cross-sectional study, methodologically, that was conducted in 2012-2013. In this study, 210 staff members of Birjand University of Medical Sciences were selected. Data collection tool was the Persian version of JeffSPLL. To investigate the factor structure of this tool, confirmatory factor analysis was used and to evaluate the model fit, goodness-of-fit indices, root mean square error of approximation (RMSEA), the ratio of chi-square to the degree of freedom associated with it, comparative fit index (CFI), and root mean square residual (RMR) were used. To investigate the reliability of tool, Cronbach's alpha was employed. Data analysis was conducted using LISREL8.8 and SPSS 20 software. RESULTS: Confirmatory factor analysis showed that RMSEA was close to 0.1, and CFI and GFI were close to one. Therefore, four-factor model was appropriate. Cronbach's alpha was 0.92 for the whole tool and it was between 0.82 and 0.89 for subscales. CONCLUSION: The present study verified the four-factor structure of the 19-item Persian version of JeffSPLL that included professional learning beliefs and motivation, scholarly activities, attention to learning opportunities, and technical skills in information seeking among the staff. In addition, this tool has acceptable reliability. Therefore, it was appropriate to assess lifelong learning in the Persian-speaking staff population.

Investigating the Quality of Life and the Related Factors in Iranian Women with Breast Cancer

Introduction: Nowadays breast cancer is the most important factor concerning the women's health which can affect the quality of life (QOL). This study was performed with aim to investigate the QOL and the related factors in Iranian women diagnosed with breast cancer in 2014-2015. Methods: This cross-sectional study was performed on 94 women with breast cancer who were selected by convenience sampling in Mashhad, Iran from 2014-2015. The data were collected through Demographic and Clinical Questionnaire and EORTC QLQ-C30.V3 Standard Questionnaire. Data was analyzed by SPSS software (version 18) and also descriptive statistics and linear regression analysis. P<0.05 was considered statistically significant. Results: The mean of total score for the quality of life was 71.45± 22.28. In the area of the symptoms of disease, the highest score belonged to insomnia (22.73± 14.89) and fatigue (19.81± 14.42). In the functional area, physical and emotional scales accounted for the highest (91.35±9.67) and lowest (78.55±2.84) scores, respectively. The results of multiple regression analysis showed that the variables of age, social status, radiotherapy, and hormone therapy are effective factors in the QOL. Conclusion: Breast cancer can affect the women's QOL. Therefore, efforts to promote the QOL in breast cancer patients is considered as one of the most important topics in women's health care. This requires more attention to identify various aspects of life and find effective ways to promote and improve the QOL in these patients.

Factors that Influence The Occurrence of Multiple Pregnancies after Intracytoplasmic Injection Cycles with Two or Three Fresh Embryo Transfers.

BACKGROUND: Multiple pregnancies are an important complication of assisted reproductive technology (ART). The present study aims to indentify the risk factors for multiple pregnancies independent of the number of transferred embryos. MATERIALS AND METHODS: This retrospective study reviewed the medical records of patients who underwent intracytoplasmic sperm injection (ICSI) cycles in Royan Institute between October 2011 and January 2012. We entered 12 factors that affected the number of gestational sacs into the poisson regression (PR) model. Factors were obtained from two study populations-cycles with double embryo transfer (DET) and cycles that transferred three embryos (TET). We sought to determine the factors that influenced the number of gestational sacs. These factors were entered into multivariable logistic regression (MLR) to identify risk factors for multiple pregnancies. RESULTS: A total of 1000 patients referred to Royan Institute for ART during the study period. We included 606 eligible patients in this study. PR analysis demonstrated that the quality of transferred embryos and woman's age had a significant effect on the number of observed sacs in patients who underwent ICSI with DET. There was no significant predictive variable for multiple pregnancies according to MLR analysis. Our findings demonstrated that both regression models (PR and MLR) had the same outputs. A significant relation existed between age and fertilization rate with multiple pregnancies in patients who underwent ICSI with TET. CONCLUSION: Single embryo transfer (SET) should be considered with the remaining embryos cryopreserved to prevent multiple pregnancies in women younger than 35 years of age who undergo ICSI cycles with high fertilization rates and good or excellent quality embryos. However, further prospective studies are necessary to evaluate whether SET in women with these risk factors can significantly decrease multiple pregnancies and improve cycle outcomes.

Determination of a Change Point in the Age at Diagnosis of Breast Cancer Using a Survival Model.

Breast cancer, the second cause of cancer-related death after lung cancer and the most common cancer in women after skin cancer, is curable if detected in early stages of clinical presentation. Knowledge as to any age cut-off points which might have significance for prognostic groups is important in screening and treatment planning. Therefore, determining a change-point could improve resource allocation. This study aimed to determine if a change point for survival might exist in the age of breast cancer diagnosis. This study included 568 cases of breast cancer that were registered in Breast Cancer Research Center, Tehran, Iran, during the period 1986-2006 and were followed up to 2012. In the presence of curable cases of breast cancer, a change point in the age of breast cancer diagnosis was estimated using a mixture survival cure model. The data were analyzed using SPSS (versions 20) and R (version 2.15.0) software. The results revealed that a change point in the age of breast cancer diagnosis was at 50 years age. Based on our estimation, 35% of the patients diagnosed with breast cancer at age less than or equal to 50 years of age were cured while the figure was 57% for those diagnosed after 50 years of age. Those in the older age group had better survival compared to their younger counterparts during 12 years of follow up. Our results suggest that it is better to estimate change points in age for cancers which are curable in early stages using survival cure models, and that the cure rate would increase with timely screening for breast cancer.