Golestan Hospital Research Articles

Factors Related to the Increase in Hospitalization Costs of the Elderly With Circulatory System Diseases in Ahvaz, Iran During 2015-2016 Using the Generalized Gamma Marginalized Two-part Model

Objectives One of the challenges facing societies today is the increased medical expenses of the elderly. Therefore, identifying the factors associated with this increase can help health policymakers control the costs imposed on the elderly and their families. This study aims to identify the factors related to the increase in hospitalization costs of the elderly with circulatory system diseases using the generalized gamma marginalized two-part model. Methods & Materials In this retrospective cohort study, 335 samples were selected by a simple random sampling method from among the older patients of Imam Khomeini and Golestan hospitals in Ahvaz, Iran during 2015-2016 having circulatory system diseases and age ≥60 years. The relationship of age, gender, hospitalization status in intensive care unit (ICU), marital status, admission season, and number of hospitalization days with the increase in treatment costs of the elderly was examined using the generalized gamma marginalized two-part model in SAS 9.4 software. The response variable was the patients’ treatment costs. The significance level was set at 0.05. Results The mean age of participants was 70.718.27 years, where 54% were female and 46% were male. The average medical costs in patients admitted to ICU was 3.70 times higher than that in patients who were not admitted to this unit. The odds ratio showed that, for each day of increase in hospital stay, the hospitalization costs of the patients increased by 1.11. The hospitalization costs for older men were 1.67 times higher than in older women. In single patients, it was 2 times higher than in married patients. Moreover, with each year of increase in age (after age 60), the hospitalization costs increased by 0.96. Using the marginalized two-part model, it was found that the variables of age, number of hospitalization days, marital status, gender, and admission to ICU had a significant relationship with the increase in the hospitalization costs of the elderly (P<0.05). Conclusion The burden of hospitalization costs on younger elderly with circulatory system diseases is higher. Older men incur more hospital costs than older women, and single elderly people incur more hospital costs than married ones. The increase in the number of hospitalization days is another factor that can increase the hospitalization costs of the older patients, especially in those admitted to ICU.

A comparison of magnesium sulfate plus morphine with morphine alone for acute pain reduction in long-bone fractures; a double blind randomized clinical trial

Introduction: Acute pain is a common symptom in patients with bone fractures referring to the emergency department (ED). Objectives: The present study aimed at evaluating the efficacy of intravenous (IV) magnesium sulfate in controlling acute pain of long-bone fractures in EDs. Patients and Methods: The present double-blind, randomized clinical trial was conducted on patients with isolated limb fractures referred to Golestan hospital of Ahvaz from 2019 to 2020. Patients in the intervention group were injected with 0.1 mg/kg morphine plus 30 mg/kg magnesium sulfate and 0.1 mg/kg morphine alone in the morphine group. The patient’s pain scores were measured at 0, 15, 30, 45 and 60 minutes after injection. The patients’ condition was monitored every 10 minutes, including respiratory and pulse rate, blood pressure, and knee reflex. Results: The present study was conducted on 64 patients with long-bone fractures allocated to two groups of IV morphine plus magnesium sulfate and IV morphine alone (each of 32). The hemodynamic factors and mean body temperature did not significantly change after intervention and had a similar level in both groups. Before the intervention, the mean score of pain was measured in the morphine and magnesium sulfate plus morphine groups using a visual analogue scale. Results which were 8.87±0.83 and 8.93±0.94, respectively, showing no significant differences (P=0.69). After 60 minutes, the pain score reduced considerably in both groups. Conclusion: In the study, magnesium sulfate plus morphine could better reduce pain than morphine alone without influencing the respiratory rate. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical Trials (IRCT20190617043913N1; https://en.irct.ir/trial/40370, ethical code# IR.AJUMS.REC.1398.143).

Quality of Life of Parents of Children With Refractory Seizures Referred to a Hospital in Ahvaz, Iran

Background and Objectives Up to 25% of children with epilepsy experience resistance to treatment and recurrence of seizures and have low quality of life (QoL) in various dimensions. Limited evidence is available on the QoL of the parents of these patients in the south of Iran. Therefore, this study aims to evaluate the QoL of parents with children having refractory epilepsy in Ahvaz, Iran Subjects and Methods Using a sequential sampling method, 157 parents of 113 children with refractory epilepsy who referred to the neurology clinic of Golestan Hospital in Ahvaz city during 2009-2016 were selected to participate in the study. The 36-item short form health survey (SF-36) was used to assess the QoL of parents. The significance level of statistical tests was set at 0.05. Results The mean age of parents was 35.2±8.5 years and the mean age of children was 7.1±2.6 years. Of 157 parents, 98 (62.4%) were mothers and the rest were fathers. The children had seizures for 3.1±1.6 years. The mean score of SF-36 was 62.6±21.4. In all domains of the SF-36, mothers had significantly lower scores than fathers (P<0.000). Conclusion The QoL of parents with children having resistant epilepsy, especially their mothers, in Ahvaz is lower compared to the general population of Iranian

The Effect of Family’s Scheduled Visitation on Vital Signs and Satisfaction Level of Patients Admitted to the Cardiac Care Unit: A Randomized Clinical Trial

Background: Visiting the family can have a great impact on hospitalized patients. Investigation of these effects is necessary to provide better care for patients admitted to the cardiac care unit (CCU). Methods: This randomized clinical trial study was performed in the Golestan Hospital in Ahvaz, Iran, in 2021. Sixty-two CCU patients were randomly allocated to intervention and control groups. The scheduled family visit was performed twice a day, 60 minutes each time, for 3 days in the evening and night shifts for the intervention group. The routine family visit was used for the control group. Data were collected by a satisfaction questionnaire and a checklist on vital signs. Data were analyzed using the chi‑square, t-test, and generalized estimating equations (GEE). Results: In the intervention group, unlike the control group, there was a significant difference between the mean heart rate and systolic blood pressure of patients during different times (P < 0.000). Also, the level of satisfaction was higher in the intervention group than controls (P < 0.000). Conclusions: This study demonstrated that scheduled family visits not only did not interfere with patients' vital signs but also increased their satisfaction. Therefore, it is necessary to design appropriate visitation policies for patients admitted to the cardiac intensive care unit.

The Effect of Ginger (Zingiber officinale Rosc.) Consumption in Headache Prophylaxis in Patients with Migraine: A Randomized Placebo-Controlled Clinical Trial

Background: Migraine sufferers seek a range of treatments according to the frequency and severity of their symptoms. Just a few research studies have shown the effectiveness of ginger derivatives for migraine treatment. Ginger has analgesic properties and is effective for the acute treatment of migraines, and there is anecdotal evidence of its effectiveness in migraine prevention. Objectives: The goal of this research was to see whether ginger may help prophylaxis of migraine episodes. Methods: This randomized, double-blind, placebo-controlled clinical study was done in the Neurology Clinic of Golestan Hospital (Ahvaz, Iran). This research enrolled 103 individuals with episodic migraine aged 18 to 50 years. Randomization was used to divide the participants into two groups: Control and intervention. For three months, patients were given 500 mg dry extract of ginger (5% active component) or placebo (starch) tablets twice a day. At the baseline and end of the study, MIDAS score, the number and duration of migraine attacks, headache severity, demographic data, dietary intakes, and anthropometric indices were collected. The data were statistically analyzed using the SPSS (version 26). In all tests, a P < 0.05 was deemed statistically significant. Results: At the end of the study, MIDAS score, duration of migraine attacks, and headache severity decreased significantly in the ginger group compared to the placebo group (P < 0.05). Furthermore, there was no statistically significant difference in the number of migraine episodes between the two groups. Conclusions: Compared to the placebo, ginger has a stronger efficacy in the prevention of migraine.

Evaluation of the Relationship Between Changes in Potassium Concentration and Arrhythmia During Coronary Artery Bypass Grafting Surgery.

BackgroundCoronary artery bypass grafting (CABG) surgery is a treatment option for coronary artery diseases. Cardiac arrhythmias during CABG surgery can lead to serious complications. Potassium ion concentration is a factor involved in such arrhythmias. ObjectivesThis study aimed to investigate the relationship between potassium concentration and cardiac arrhythmias in CABG surgery.MethodsThis descriptive cross-sectional study was performed on 60 patients with the American Society of Anesthesiologists class I, II, and III undergoing CABG surgery at Golestan Hospital, Ahvaz, Iran. All patients underwent general anesthesia, and ventilator control was achieved by mechanical ventilation. The on-pump method was used for CABG. Potassium levels were measured at several time points during surgery. All cardiac arrhythmias were recorded. Mean arterial pressure (MAP), serum level of potassium, blood sugar, blood urea nitrogen (BUN), creatinine, calcium, magnesium, hemoglobin (Hb), and sodium were also recorded.Results The mean age of the patients was 60.87 ± 7.35 years, and 45% of the subjects were female. Moreover, there was no statistically significant difference between the patients. There was a significant relationship between the changes in MAP, potassium, blood sugar, BUN, creatinine, calcium, and magnesium with the incidence of cardiac arrhythmias (P < 0.05). However, no significant relationship was noted between Hb and sodium levels with the incidence of cardiac arrhythmias (P < 0.05).ConclusionsThe changes in potassium levels increase the risk of cardiac arrhythmias and their complications.

A Survey of Shift Work and Work Ability Index among Nurses: A Case Study in Educational Hospital, Ahvaz, Iran

Shift work is a social phenomenon with adverse effects on the lives and health of people in various aspects. This adverse effect decreases shift workers’ ability over a time period. The aim of the present study was to survey disturbances due to shift work and some disorders associated with work ability index among nurses in educational hospitals, Ahvaz, Iran. This cross-sectional survey was conducted among 33 nurses at the Golestan Hospital, Ahvaz, Iran. The survey of shift workers questionnaire (SOS) and the Work Ability Index (WAI) questionnaire was used as data collection tools. The related data was analyzed based on the descriptive statistics, Pearson correlation test, and Spearman correlation test using IBM SPSS software version 19. The results showed that 97% of problems related to the effects of shift work on the individuals’ lives, families, and musculoskeletal disorders, 87.9% related to insomnia and social problems, and 75.8% related to mental disorders. Although it showed a significant relationship between the workability index with the variable of experience and mental disorders, it showed no significant relationship between the prevalence of insomnia and musculoskeletal disorders variables. The results of this study showed that shift working disrupts mental, social, and physical health that ultimately adversely affect the ability of shift workers. Therefore, it was recommended to adjust working hours and allocate the appropriate shifts to improve the workability of individuals.

A comparative study on the effectiveness of topiramate and propranolol in patients with migraine with aura

Background: Migraine is considered as one of the most common and disabling diseases of the nervous system that has a great impact on quality of life (QOL) and a little risk of neurologic complications such as stroke. Migraine aura is known to be the result of cortical spreading depression and is associated with higher risk of this complication. Thus, the present study was conducted with the aim to compare the effects of topiramate as an antiepileptic, and propranolol in patients with migraine with aura. Methods: The present randomized clinical trial was conducted on patients with migraine with aura referred to the neurology clinic of Golestan Hospital, Ahvaz, Iran, in the period of 2019-2020. The patients were randomized into two groups and received either topiramate or propranolol. The Migraine Disability Assessment Scale (MIDAS) score was evaluated before and at the end of three months after initiating the treatment. Results: Reduction in the MIDAS score in patients taking topiramate (-16.94) was greater than that in the propranolol group (-14.5), but this difference was not statistically significant (P > 0.005). No significant relationship was found between gender and changes in the MIDAS score after the treatment of both groups (P > 0.050). However, the changes in the MIDAS score were greater in younger patients, and this relationship was statistically significant (P < 0.050). Conclusion: There was no significant difference in the efficacy of topiramate and propranolol in patients with migraine with aura. No significant relationship was found between gender and changes in the MIDAS score after the treatment in both groups, but the reduction in the MIDAS scores was significantly higher in younger patients of both groups.

The effects of hot air-dried white button mushroom powder on glycemic indices, lipid profile, inflammatory biomarkers and total antioxidant capacity in patients with type-2 diabetes mellitus: A randomized controlled trial.

Background:The inflammatory and metabolic responses to mushroom in type 2 diabetes mellitus (T2DM) are unknown. The study aimed to evaluate the effect of Hot Air-dried White Button Mushroom (HAD-WBM) powder on glycemic status, lipid profile, inflammatory markers, and total antioxidant capacity (TAC) in T2DM patients.Materials and Methods:This randomized controlled trial was conducted at Golestan Hospital, Ahvaz, Iran. Eligible patients were adults aged 20–50 with Type 2 diabetes. Patients were assigned to each group using a randomized block design with block randomization (n = 22, in each group). Randomization was performed by an assistant and group allocation was blinded for the investigator and participants. The intervention and control groups received 16 g/day HAD-WBM or cornstarch powder for 8 weeks. The primary outcomes of interest were fructosamine, fasting blood sugar (FBS), insulin, homeostatic model assessment for insulin resistance, and secondary outcomes were triglyceride, low-density lipoprotein (LDL), high-density lipoprotein, very-LDL, cholesterol, high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and TAC.Results:After 8 weeks, a significant decrease was observed in fructosamine (−0.228 ± 0.36 vs. 0.03 ± 0.38; P = 0.02) and LDL (−13.05 ± 20.67 vs. 0.81 ± 21.79; P = 0.04) in the HAD-WBM group compared to the control group. No significant changes were observed in fasting insulin and FBS between the two groups. However, a significant within-group reduction (−28.00 ± 42.46; P = 0.006) was observed for FBS in the HAD-WBM group. In the HAD-WBM group, insulin resistance reduced significantly at the end of the study (From 4.92 to 3.81; P = 0.016), but it was not significantly different between the two groups. There was no significant difference in TAC, hs-CRP, and IL-6 between the two groups.Conclusion:Considering the results of this study about the beneficial effects of HAD-WBM on the improvement of glycemic indices and LDL in T2DM patients, it is recommended that HAD-WBM could be used to control T2DM.

Investigating the effect of magnesium supplement in patients with major depressive disorder under selective serotonin reuptake inhibitor treatment.

Major depression disorder (MDD) is a mental disorder that affects millions of people worldwide. This disease has negative impacts on quality of life and psychological-related functions. This is a multifactorial disorder; both genetic background and environmental factors have their role. Antidepressants are prescribed as the first line of treatment for patients with depressive disorders. Selective serotonin reuptake inhibitor (SSRI) antidepressants are used to treat MDD and anxiety; however, some patients do not respond to them. Regarding that, magnesium plays a major role in mood regulation; therefore, this study aimed to investigate the role of magnesium supplement in patients with MDD and under an SSRI treatment regimen. In this randomized, double-blind controlled trial, 60 patients with major depressive disorders based on the DSM-V diagnosis referred to Golestan Hospital in Ahvaz, Iran, were included. The eligible patients were categorized randomly into two thirty-people groups receiving magnesium (intervention) and placebo (control) along with SSRI for 6 weeks. To evaluate the depression status, the Beck II test was applied. Subjects were examined before and after the intervention. There was no statistically significant difference between the two groups in terms of demographic characteristics (P > 0.05). The mean Beck scores at the beginning of the study and the second week after the intervention were not different between the two groups (P = 0.97, P = 0.56), whereas the mean Beck scores were lower in the intervention group than in the control group in the fourth and sixth weeks after the intervention (P = 0.02 and P = 0.001, respectively). Administration of Mg supplement for at least 6 weeks might improve depression symptoms. It can also be considered as a potential adjunct treatment option for MDD patients who are under SSRI treatment.

Surgical early complications of the laparoscopic insertion of peritoneal dialysis catheter: A cross-sectional descriptive two-center study in Ahvaz, southwest of Iran

Objectives: This study aimed to investigate the surgical complications of this technique of peritoneal dialysis catheter insertion in Imam Khomeini and Golestan hospitals in Ahvaz, southwest of Iran, in the period between 2007 and 2019. Methods: In this retrospective cross-sectional analytic-descriptive study, we examined end-stage renal disease (ESRD) patients who underwent laparoscopic peritoneal dialysis catheter insertion between 2007 and 2019. Patients' records and follow-up information recorded in the hospital dialysis unit were reviewed and early infectious and mechanical complications of peritoneal dialysis catheter insertion were analyzed. Results: In this study, 290 patients (144 males and 138 females) with ESRD who have a mean age of 46±19.7 years (1-90 years) were recruited, of whom 8 patients were excluded due to incomplete information in their records, and 68 patients (24.1%) had an early complication of surgery. Surgical complications included: Catheter exit-site infections in 20 patients (7.1%), peritonitis in 18 patients (6.4%), catheter exit-site leakage in 17 patients (6%), catheter occlusion without migration in 16 patients (5.7%), catheter migration in 7 patients (2.5%), and hemoperitoneum in 7 patients (2.5%). Conclusions: Due to the low complications of laparoscopic surgery in the insertion of a peritoneal dialysis catheter, this technique is recommended as a safe surgical procedure with low complications.

The Effect of a Training Program Based on Roy’s Adaptation Model on the Adaptation of Patients Undergoing Coronary Artery Bypass Graft in Intensive Care Units

Background: One of the effective nursing measures for enhancing the quality of life (QOL) and adaptation of patients undergoing coronary artery bypass graft (CABG) is the use of Roy’s adaptation model (RAM). Objectives: This study aimed to determine the effect of a training program based on Roy’s adaptation model on the adaptation of patients undergoing CABG. Methods: This quasi-experimental study was performed on 60 patients admitted to the intensive care units (ICUs) of Imam Khomeini Hospital and Golestan Hospital in Ahvaz, southwest of Iran, in 2020. Patients were selected based on inclusion criteria and randomly assigned into intervention and control groups. A four-session training program based on RAM was held for the intervention group. Data were analyzed using SPSS ver. 22. Results: The mean scores of physiological, self-concept, role function, and independence and interdependence dimensions in the experimental group before the intervention were 48.76 (6.36), 23.76 (4.10), 19.60 (2.93), and 25.60 (3.54), respectively. After the intervention, the mean scores in the mentioned dimensions were 101.26 (5.23), 50.80 (3.82), 39.10 (4.15), and 25.47 (3.99), respectively, indicating an upward trend (P &lt; 0.05). Also, the mean score of total adaptation before the intervention was 117.73 (12.00), which rose to 216.63 (7.88) after the intervention (P &lt; 0.05). Conclusions: The results showed that RAM plays an important role in the adaptation of patients undergoing CABG surgery. Thus, this model can provide a suitable framework for examining and providing care for patients undergoing CABG in ICUs.

Evaluation of Blood and CSF Isolated Bacteria and Their Antimicrobial Resistance in Hospitalized Patients in Ahvaz Golestan Hospital in 2020

Background and Objectives: Infection of the blood and cerebrospinal fluid can have irreparable consequences and even death. In the present study, the prevalence of bacteria causing blood and cerebrospinal fluid infection and their antibiotic resistance in hospitalized patients was investigated. Subjects and Methods: In this present descriptive-cross-sectional study, the results of all blood and cerebrospinal fluid samples were sent for culture from the hospitalized patients of Golestan Hospital in Ahvaz in the first six months of 2019 were examined. Relevant information was extracted from patients’ medical records. Results: In this study, 12.17% of blood culture were positive and 7.6% of cerebrospinal fluid culture were positive. The most common bacteria causing blood infections were Staphylococcus Coagulase Negative (32.5%), Klebsiella (24.1%) and Pseudomonas (21.7%), and the most common bacteria causing cerebrospinal fluid infection were Klebsiella (30.9%), Streptococcus. group D (Enterococcus) (20.6%) and pseudomonas (15.5%). The highest bacterial resistance was observed for Ampicillin, Ceftriaxone, Cefazolin, Cefixime and Cefotaxime antibiotics, and the highest sensitivity was observed for Meropenem, Colistin, and Levofloxacin antibiotics. Conclusion: Since the bacterial resistance pattern is always changing, it is suggested that before starting any empirical treatment in infectious diseases, sensitive antibiotics for common bacterial agents are recommended for a more efficient treatment.

Randomised trial of IV metoclopramide vs IV ketorolac in treatment of acute primary headaches.

Headache is one of the most common neurological conditions among emergency department visits (ED), although the best therapy has not been identified yet. Therefore, in the current study, we aimed to compare the pain-relieving effect of metoclopramide and ketorolac in acute primary headaches patients. This double-blind, randomised clinical trial was conducted at Golestan Hospital, Ahvaz, Iran. This research involved all adult patients with acute primary (migraine or tension-type) headaches presented to the ED. Pain intensity was assessed with 0 to 10 verbal Numeric Rating Scales (NRS). The subjects were randomised into 10mg intravenous (IV) metoclopramide or 30mg IV ketorolac groups. Pain score and drug adverse reactions were compared between the two groups at baseline, 15, 30, and 60min after baseline. 108 patients completed this trial and were equally divided into two groups (mean age of 34±8.54years; 57.4% female). Before treatment, the mean pain score was 6.9 and 6.8 in metoclopramide and ketorolac groups, respectively (p>0.05). Metoclopramide failed to provide more improvement in pain score at 30min (p=0.55) and 60min (p=0.15) from baseline. There were no serious adverse events in this study. Only five patients required rescue medication which four of them were in ketorolac group. We were unable to reject the null hypothesis that there would be no difference in pain outcomes between metoclopramide and ketorolac.

Survey of Frequency, Clinical Characteristics and Causes of Seizure in Children Younger Than Five Years With Acute Gastroenteritis Admitted to Ahvaz Golestan Hospital Over a Two Year Period

Background and Objectives Acute gastroenteritis is a highly prevalent disease in children. Various factors may causes seizure in children with gastroenteritis. This study was designed to determine the frequency, clinical characteristics and causes of seizure in children younger than 5 years with acute gastroenteritis admitted to Ahvaz Golestan hospital. Subjects and Methods In a retrospective descriptive study based on hospital records , 339 children under 5 years old who were admitted to Ahvaz Golestan hospital during 2016 - 2017 were assessed. Patients with underlying neurological disorders were excluded and the recorded information of patients with seizure was reviewed. Results Out of 339 reviewed cases, 59 patients (17.4%) had seizures, most prevalent in13 to 24 months age group (28.8%). In 74.6% of cases, type of diarrhea were dysentery. 64.4% had mild dehydration. Encephalopathy was detected in 1.7%, shigellosis in 6.8%, hyponatremia in 32.2% and hypernatremia in 3.4%. Seizures in 52.5% of cases were considered as febrile Seizure. Diagnostic criteria of benign convulsions associated with mild gastroenteritis (CwG) were present in 5% of patients. 79.7% of cases had generalized seizures. In comparison, a significant relationship was observed between the febrile and non-febrile groups only in the variable of diarrhea type. Conclusion The results show that fever and electrolyte imbalances and among infectious agents, Shigella are important causes of seizures in patients with gastroenteritis. In patients with dysentery, seizures are more likely.

Survey Method of Vascular Surgery on the Onset of Ischemic Steal Syndrome Following Vascular Access in Dialysis Patients

Background: Access to arteries is one of the most appropriate approaches for helping chronic kidney diseases. Objectives: The aim of the present study was to evaluate the survey method of vascular surgery on the onset of ischemic limb syndrome following vascular access in dialysis patients. Methods: In this cross-sectional study, the population study was patients with end-stage renal disease (ESRD) referring to Ahvaz Golestan Hospital in 2018. Control of limbs temperature and comparison with the other side, before and after surgery, feeling cold by the patient, control of organs pulse and comparison with the other side, pain of organs comparing to the other side, pain during the dialysis, paresthesia, and movement failure and during dialysis, and organs atrophy-ulcer were measured. Results: In the present study, 294 patients, including 139 women (46.94%) and 156 men (53.06%), were studied. Ischemic steal syndrome (ISS) was observed in 20 patients, that 13 cases of them had benefited from fistula approach and 7 patients used graft approach. The most common observed ISS was related to brachiocephalic fistula approach (AVF-Brachiocephalic) and then graft in arm. In non-steal syndrome group, brachiocephalic fistula (AVF-Brachiocephalic) had the most common application. In the present study, there was no significant correlation between access method and underlying diseases of high blood pressure, diabetes, and cardiac ischemic diseases. Conclusions: One of the most important results of the present study was the highest existence of steal syndrome in brachiocephalic approach, which is confirmed by other studies.

185 THE EFFECT OF PSYCHOLOGICAL PREPARATION ON THE LEVEL OF ANXIETY BEFORE UPPER GASTROINTESTINAL ENDOSCOPY

Abstract Anxiety is one of the problems in patients undergoing invasive procedures. One way to control anxiety is through psychological preparation. This study was aimed to evaluate the effect of psychological preparation on anxiety level in patients undergoing upper gastrointestinal endoscopy. Methods The present study consisted of 98 patients which were referred to Ahvaz Golestan Hospital for upper gastrointestinal endoscopy. They were randomly (table of random numbers) divided into a control group and an experimental group. All of the participants filled out Spielberg State–Trait Anxiety Inventory (STAI). The experimental group was psychologically prepared for endoscopy (given information about endoscopy and behavioural intervention), and then both groups were asked to complete STAI again an hour before endoscopy. The collected data were analysed through Mann–Whitney, Kruskal-Wallis, and Chi-square tests using SPSS 17.0. Results Before the intervention was carried out, there was no significant difference between the two groups in terms of the rate of state and trait anxiety (p &amp;gt; 0.05). After the intervention, the rate of state and trait anxiety decreased significantly (p &amp;lt; 0.05) in experimental group. Conclusion In patients subjected to endoscopy, psychological preparation was effective in reducing their anxiety and thus this can be considered as an efficient method in decreasing anxiety.

Evaluation of the Effect of Atorvastatin Administration on the Outcomes of Patients with Traumatic Brain Injury: A Double-blinded Randomized Clinical Trial.

BackgroundTraumatic brain injury (TBI) is one of the common causes of long-term disabilities and mortality. This study aimed to evaluate the effect of atorvastatin administration on the Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS), and Disability Rating Scale (DRS) in patients with TBI.MethodsThis double-blinded randomized clinical trial included 60 patients with TBI in Golestan Hospital of Ahvaz, Iran. After obtaining an informed consent from all patients, the patients were randomly assigned into two groups. For the intervention group, atorvastatin with a daily dose of 20 mg was used. The control group was administered the same amount of placebo for 10 days. Changes in the level of consciousness were measured using the GCS, and functional recovery rate in patients was measured by GOS and DRS in the third follow-up month.ResultsAccording to the obtained results, compared with the control group, the atorvastatin administration significantly increased the level of GCS and DRS within 2 - 3 months post-intervention and improved GOS since the tenth day after the study (P < 0.05).ConclusionsThe results revealed the positive effect of atorvastatin on the improvement of outcomes measurements such as GCS, DRS, and GOS in patients after moderate and severe TBI.

Epidemiological and clinical characteristics of the COVID-19 epidemic and associated factors for mortality in Golestan province, Iran: a retrospective cohort study.

SummaryBackgroundWe aimed to further clarify the epidemiological and clinical characteristics of 2019-nCoV pneumonia and risk factors associated for mortality.MethodsIn this study, we included inpatient with acute respiratory distress syndrome at Golestan Hospitals who had been discharged or had died in 2020. Epidemiological, and clinical data were extracted from electronic medical records and compared between recovered and died cases. We used multiple logistic regression methods to explore the risk factors associated with in-hospital death.ResultsOverall 2,835 acute respiratory distress syndrome patients were included in this study, and 874 (30.83%) were positive for 2019-nCoV. Five hundred and sixty-three patients (19.86%) died, 1,687 patients (59.51%) were recovered. Of the total deaths, only 288 (10.15%) were attributed to COVID-19. The most common symptoms at onset of illness were respiratory distress [1,795 (63.32%)], fever [1,601 (56.47%)], dry cough [1,595 (56.26%)], sore throat [445 (15.70%)], and myalgia [342 (12.06%)]. One thousand and twelve (35.7%) had 1 or more coexisting medical conditions. In multiple logistic regression analysis, risk factors associated with the death included older age [OR (Odds Ratio) = 1.03; 95% CI; 1.02-1.04], blood oxygen level (SPO2 < 93%) (OR = 2.44; 95% CI; 1.79-3.31), comorbidities (OR = 2.15; 95% CI; 1.62-2.84), respiratory distress (OR = 1.74; 95% CI; 1.28-2.37), and headache (OR = 0.44 95% CI; 0.21-0.92).ConclusionsThe 2019-nCoV infection caused collections of severe respiratory illness and was associated to a high ratio of hospitalization in ICU and high mortality. Older age and comorbidities were associated with more risk of death among patients with 2019-nCoV.

The Effect of Pain Self-Management Education on Pain Severity and Quality of Life in Metastatic Cancer Patients

Objective:Proper pain control in cancer patients is one of the prime needs of metastatic cancer patients. It is, then, one of the essential objectives of health care workers. The present study aimed to pinpoint the impact of pain self-management education on the pain severity and the quality of life in patients with metastatic cancers using complementary medicine approaches.Methods:This clinical trial study was performed in the Oncology Specialty Clinic of Ahvaz Golestan Hospital on 82 metastatic cancer patients picked based on inclusion criteria. They were randomly assigned to two groups: the intervention group and one as the control group. In the intervention group, pain self-management was taught in the three steps of providing information, skill development, and guidance. Self-management approaches were also practically taught face to face along with feedback. Furthermore, the quality of life was measured at 1-and 3-month follow-ups and the pain severity was measured during 7 weeks. In the control group, the quality of life questionnaire and the pain severity checklist were given to the participants to fill out. Finally, data were analyzed through SPSS version 22 in general and repeated-measures ANOVA and Friedman tests.Results:It was observed that after the intervention, the trend of pain severity during weeks 1–7 was significantly different in the intervention and control groups (P < 0.0001). In addition, a significant difference was observed for the quality of life at 1 and 3 months after the intervention between the two studied groups (P < 0.0001).Conclusions:Findings of the present study indicate a positive impact of pain self-management on improving pain severity and the indicators of quality of life in metastatic cancer patients. Accordingly, the current study findings can help nurses, nursing students, and other team members improve pain control skills and subsequently increase the quality of life in patients with metastatic cancers.