Hospitals In Kermanshah Research Articles

Comparison of the Logical Use of Parenteral Antibiotics Before and After the Implementation of the Stewardship Program

Background: Excessive use of antibiotics has led to drug resistance. As such, stewardship programs are implemented to control antibiotic use in hospitalized patients. Objectives: The present study aimed to evaluate the frequency of antibiotic use after the implementation of the stewardship program. Methods: This retrospective study was conducted on the patients admitted to Imam Reza Hospital in Kermanshah, Iran during 2017 - 2018. The required data were extracted from the pharmaceutical ward of the hospital. Data analysis was performed in SPSS version 24. Results: The median per capita numerical and Rial consumption of caspofungin and linezolid antibiotics increased after the implementation of the stewardship plan, while the consumption of imipenem, amphotericin, teicoplanin, colistin, meropenem, voriconazole, and vancomycin was observed to decrease. In addition, the median per capita of the numerical use of caspofungin and linezolid increased in the surgery ward, intensive care unit (ICU), and internal medicine ward after the implementation of the stewardship plan. On the other hand, a reduction was observed in the use of amphotericin, colistin, voriconazole, and vancomycin in only one ward. The use of meropenem and teicoplanin also increased in the surgery ward and decreased in the other wards, while the use of imipenem increased in the ICU after implementing the plan and decreased in the other wards. The median use of antibiotics was not considered significant in the internal medicine ward, surgery ward, and ICU before and after implementing the stewardship program (P > 0.05). Conclusions: According to the results, antibiotic use slightly decreased after the implementation of the stewardship program. However, an increase was also observed in antibiotic prescription in some cases, which indicated that the stewardship program was not implemented properly, and no changes occurred in antibiotics prescription.

Evaluation of Liver Enzyme Levels in Patients with SARS-CoV-2 Infection

Background: Although coronavirus disease 2019 (COVID-19) is a respiratory disease, it seems that liver abnormalities are also prevalent in the patients. Objectives: The present study aimed to evaluate liver enzymes in COVID-19 patients. Methods: This descriptive, cross-sectional study was conducted on 111 COVID-19 patients admitted to Imam Reza Hospital in Kermanshah during September-November 2020. The required data were extracted from the hospital files, and data analysis was performed in the Excel software and SPSS version 21. Results: The mean age of the patients was 60.87 ± 15.85 years. 50.5% of patients were female. Among the patients, 38.7% had hypertension, 19.8% had diabetes, and 7.2% had cardiovascular diseases. Moreover, 34.2% of the patients had abnormal aspartate aminotransferase (AST), 17.1% had abnormal alanine aminotransferase (ALT), and 100% had abnormal lactate dehydrogenase (LDH). Conclusions: According to the results, hypertension, diabetes, and cardiovascular diseases were the most common comorbidities among the COVID-19 patients. AST, ALT, and LDH are important indicators of hepatic disorders, which were abnormal in these patients as well. Moreover, the patients aged less than 60 years, male patients, and those with renal disorders had a higher mean ALT.

Evaluation of Demographic, Clinical and Laboratory Features of Patients with Systemic Lupus Erythematosus in Kermanshah

Background: Systemic lupus erythematosus (SLE) is a worldwide autoimmune disease. The disease has different etiologies, clinical and laboratory symptoms between different geographical and racial groups, and sufficient knowledge of the type of symptoms in each region can play a proper role in diagnosis and treatment. Objectives: This study was performed to evaluate demographic, clinical and laboratory features of patients with systemic lupus erythematosus in Kermanshah. Methods: This study is descriptive, analytical and cross-sectional. The files of 150 patients with lupus during 2016 - 2018 in Imam Reza hospital in Kermanshah were reviewed. Results: Data analysis showed that patients at the time of referral were with musculoskeletal symptoms 37.3% (56 individuals), cutaneous-mucosal 32% (48 individuals), constitutional 51.3% (77 individuals), renal 62% (93 individuals), cardiac 6.7% (10 individuals), neurological manifestations 17.3% (26 individuals), pulmonary involvement 37.3% (56 individuals), and Hematological 71.3% (107 individuals). The anti-nuclear antibody (ANA) in 60% (90 individuals), anti-double strand DNA Antibody (anti-ds DNA) in 35.4% (53 individuals), C-reactive protein (CRP) in 44.6% (67 individuals), lower level of normal C3 and C4 in 33.3% (50 individuals) and 11.3% (17 individuals), respectively, lupus anticoagulant in 13.3% (20 individuals), antibody citrullinated peptide anti-cyclic (anti-CCP) in 14.9% (22 individuals), anticardiolipin IgM and IgG, in 6% (9 individuals) and 9.3% (14 individuals) of patients respectively were observed. Also, anemia was observed in 34% (51 individuals), leukopenia in 22% (33 individuals), and thrombocytopenia in 30.7% (46 individuals). Abnormal ESR (erythrocyte sedimentation rate) was seen in 59.3% (89 individuals) of patients. Leukopenia in men and positive CRP in women were more common (P = 0.014, P = 0.004). Conclusions: Despite the diverse clinical and laboratory manifestations of SLE in different racial and geographical groups, paying attention to these differences in each region can effectively diagnose the disease. As in this study, hematological manifestations had a higher percentage in the population of lupus patients in Kermanshah.

Cardiopulmonary Resuscitation Outcomes of Patients with COVID-19; a One-Year Survey.

Introduction:Assessing cardiopulmonary resuscitation (CPR) outcomes of patients with COVID-19 and employing effective strategies for their improvement are essential. This study is designed in this regard. Methods:This cross-sectional study was conducted between January 20, 2020 and January 20, 2021 in the emergency departments of two hospitals in Hamadan and Kermanshah, Iran. Participants were 487 patients with confirmed COVID-19 and cardiac arrest (CA) who had undergone CPR during the study period. Data were collected using the available CPR documentation forms developed based on the Utstein Style and analyses were performed using Chi-square, Fisher’s exact, and Mann-Whitney U tests and the logistic regression analysis.Results:Participants’ mean age was 69.31±14.73 years and most of them were male (61.8%) and suffered from at least one underlying disease (58.1%). The rate of total and in-hospital CA was 9.67% and 9.39%, respectively. The most prevalent first documented rhythm was asystole (67.9%) and the highest responsivity to CPR was for shockable rhythms. The rate of the return of spontaneous circulation (ROSC) was 9% and the rate of survival to hospital discharge was 2%. The significant predictors of CPR success were age (p = 0.035), epinephrine administration time interval (p = 0.00), CPR duration (p = 0.00), and First documented rhythm (p = 0.009).Conclusion:The rate of in-hospital CA among studied COVID-19 cases was 9.39% with 9% ROSC and 2% survival to hospital discharge rates after CPR. Primary CPR success among patients with COVID-19 was poor, particularly among those with asystole and bradycardia. It seems that old age and improper doses of epinephrine can reduce CPR success.

CORRELATION OF COMPUTED TOMOGRAPHY AND INTRAOPERATIVE FINDINGS WITH CLINICAL SYMPTOMS IN HEAD TRAUMA PATIENTS

Hematoma in different parts of the brain is one of the most important complications of head injury and is associated with high mortality and morbidity rate. The aim of this study was evaluation of the relationship between Computed Tomography (CT) and intraoperative findings with clinical symptoms in head trauma patients. In this study 95 patients with cerebral hemorrhage due to head trauma, referred to Taleghani Hospital in Kermanshah were studied. After an initial clinical examination, the level of consciousness determined according to the Glasgow Coma Scale (GCS) was recorded. All patients underwent brain CT scan and findings were recorded, including size and location of the hematoma. Patients in all treatment such as surgical procedures under the supervision, and the information on their status was recorded until discharge or death. It was found that most patients (38%) were between 40-20 years: 73% of patients were male, while 27% were female. The outcome of 35 patients (35.4%) were normal, 12 patients (12.3%) had moderate disability, 9 patients (9.2%) had severe disability, 11 patients (10.8%) vegetative state and 31 patients (32.3%) died. There was a significant association between location of the hematoma and hematoma in CT scan and outcome of patients with cerebral hemorrhage caused by trauma (P<0.05). We also found a significant association between size of the hematoma and midline shift in CT scan with outcome of patients with cerebral hemorrhage caused by trauma (P<0.05). The prognosis of patients with traumatic brain injury depends on location of the hematoma; volume of hematoma, midline shift in CT scan and length of trauma to surgery more than 4 hours.

The Effect of Preoperative Electronic Education on Anxiety of Patients Undergoing General Surgery

Background: Preoperative anxiety is a common problem of surgical patients because it causes a range of emotional, psychological and physical problems. Numerous pharmacological and non-pharmacological methods have been used to reduce the level of anxiety in patients undergoing general surgery. Objectives: The aim of this study was to evaluate the effect of electronic education on preoperative anxiety in patients undergoing laparoscopic cholecystectomy (LC). Methods: The present study was a randomized controlled trial on 88 patients who were candidates for LC in two intervention and control groups in one of the Kermanshah hospitals. Patients in the intervention group received electronic education before surgery. The Visual Analog Scale Anxiety (VAS-A) questionnaire was used to measure anxiety before surgery in the study. Data analysis was performed using SPSS statistical software. Results: The results showed that there was no significant difference in the level of basic anxiety between the intervention and control groups. In second VAS-A evaluation, a significant mean difference was observed between the two groups so that the anxiety of the intervention group was calculated as 26.1 ± (SD = 16) vs. the control group as 45 ± (SD = 21). The mean of post-intervention anxiety compared to pre-intervention anxiety significantly decreased in the intervention group. Conclusions: Our findings highlight that electronic-based education can reduce the preoperative anxiety level in LC patients. Therefore, it's recommended to medical staff for delivering pre-surgery electronic educational interventions for LC surgical patients in order to reduce the level of preoperative anxiety.

Eliciting preferences of patients about the quality of hospital services in the west of Iran using discrete choice experiment analysis

ObjectivesKnowing about accurate customer expectations is the most important step in defining and delivering high-quality services. This study aimed to evaluate the preferences of patients referring to two hospitals in Kermanshah, Iran.MethodDiscrete choice experiment (DCE) method used to elicit preferences of 328 patients who were admitted in two hospitals of Kermanshah city in the west of Iran. Literature review and experts opinion were used to identify a candidate list of attributes related to the quality of cares in hospitals. The final study attributes were quality of physician care, quality of nursing care, waiting time for admission, cleaning of wards and toilets, and behavior of staff. Experimental design applied to extract choice sets of hospitals. The data was analyzed by a conditional logit regression.ResultsThe regression results showed the most important predictors of hospital selection by respondents was the good quality of physician care (aOR: 3.18, 95% CI 2.61, 3.87), followed by friendly behavior of staffs (aOR: 2.03, 95% CI 1.81, 2.27), cleanness of wards and toilet (aOR: 1.61, 95% CI 1.40, 1.85), and finally quality of nursing cares (aOR: 1.13, 95% CI 0.89, 1.44). However, increasing waiting time made disutility in the study participants (aOR: 0.69, 95% CI 0.60, 0.80).ConclusionsOur study finding emphasized some potential opportunity of quality augmentation in hospital sector by paying attention to different quality attributes including quality of physician, friendly behavior of staffs, cleanness of hospital environment and finally quality of nursing cares. Considering patients preferences in decision making process could lead to substantial satisfaction improvement.

Procalcitonin Serum Level in Patients Aged 3-36 Months With Focal Fever Referred to Hospitals in Western Iran in 2020

Background: Diagnosing viral and bacterial infectious diseases in children is of great importance. The conventional treatment for the given diseases has been proven relatively impractical and, therefore, finding a practical diagnostic method seems necessary. Measuring procalcitonin (PCT) levels in the blood is one of those useful tests which have high sensitivity and specificity compared to other methods. Moreover, many researchers have emphasized that the level of PCT in bacterial infections is significant. Therefore, PCT level measurement can be adopted as a highly effective factor for distinguishing bacterial infections from viral ones. Our study aimed to evaluate the plasma levels of PCT in children aged 3-36 months. Methods: In this study which was conducted in 2020 in Kermanshah, Iran, 49 children aged 3-36 months having focal fever and referring to the pediatric emergency department of Mohammad Kermanshahi and Imam Reza hospitals in Kermanshah were examined. Distinguishing bacterial infection from viral one was first made by a pediatrician using CBC diff-ESR-CRP tests. Results: The mean serum level of PCT in bacterial infections was significantly higher than that in viral infections. Furthermore, the mean of white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) in bacterial infection was significantly higher than that in viral infection. Conclusions: According to our study findings, plasma levels of PCT could have been considered as a diagnostic indicator of the infection. Therefore, it was recommended that the evaluation of PCT plasma levels in children with infection be performed in early stages of the disease. However, it was also suggested that this evaluation be conducted after performing further investigations in this field.

Helicobacter Pylori Infection in Children with Idiopathic Thrombocytopenic Purpura

Background: Today Helicobacter pylori is the most common bacterial infection worldwide and is associated with some extra-gastrointestinal diseases such as blood disorders including idiopathic thrombocytopenic purpura (ITP). Therefore, this study was designed and performed to determine the status of Helicobacter pylori infection in children with idiopathic thrombocytopenic purpura referred to Dr. Mohammad Kermanshahi Hospital in 2019. Materials and Methods: In this cross-sectional study, 68 children with ITP were evaluated for Helicobacter pylori infection using stool antigen test. Information on Helicobacter pylori was collected using a checklist along with data on gender, age, type of ITP (acute / chronic), primary platelet counts, duration of ITP, and history of receiving treatment for H. pylori infection. Data were analyzed by SPSS-20 using descriptive statistics and the Chi-square test. Results: The mean age of all subjects was 6.35 ± 3.44 years with an age range of 1 to 13 years. The mean duration of the disease was 9.73. ± 9.04 months. Among patients, 63.24% (43 patients) were boys. Regarding the type of ITP, the highest percentage was the Acute type of disease (72/06%). Also, based on the analytical results, there was no significant relationship between Helicobacter pylori infection and gender, mean duration of infection and type of ITP (p <0.05). Conclusion: According to the results of this study, half of the ITP patients had Helicobacter pylori infection, but there was no significant relationship between the type of ITP and its duration with Helicobacter pylori infection. Therefore, it is recommended to conduct similar studies with a larger sample size and perform follow-ups to achieve more accurate results

Evaluation of the causes of prescription deductibles in a teaching hospital in Kermanshah

Evaluation of the causes of prescription deductibles in a teaching hospital in Kermanshah

Increased incidence of rhino-orbital mucormycosis in an educational therapeutic hospital during the COVID-19 pandemic in western Iran: An observational study.

BackgroundCOVID‐19 patients, especially the patients requiring hospitalisation, have a high risk of several complications such as opportunistic bacterial and fungal infections. Mucormycosis is a rare and opportunistic fungal infection that mainly affects diabetic and immunocompromised patients. An increase has been observed in the number of rhino‐orbital mucormycosis in patients with COVID‐19 admitted to Imam Khomeini Hospital, Kermanshah, Iran, since October 2020. This is a report of the frequency, risk factors, clinical manifestations, treatment and prognosis of COVID‐19 associated with mucormycosis infection.MethodsThe medical records of COVID‐19 patients with rhino‐orbital mucormycosis who were diagnosed in an educational therapeutic hospital in Kermanshah, west of Iran were surveyed. Several parameters were analysed including demographic, clinical, therapeutic and laboratory characteristics.ResultsTwelve patients with COVID‐19–associated rhino‐orbital mucormycosis were identified from 12 October to 18 November 2020. All cases reported as proven mucormycosis had a history of hospitalisation due to COVID‐19. Comorbidities mainly included diabetes mellitus (83.33%) and hypertension (58.33%). Seventy‐five per cent of patients received corticosteroids for COVID‐ 19 treatment. The sites of involvement were rhino‐sino‐orbital (83%) and rhino‐sino (17%). Amphotericin B/liposomal amphotericin B alone or in combination with surgical debridement or orbital exenteration was used as the first‐line therapy. The overall mortality rate was 66.7% (8/12).ConclusionsWe found a high incidence of mucormycosis among COVID‐19 patients. Diabetes mellitus and corticosteroid use were the dominant predisposing factor of mucormycosis. Mucormycosis is a life‐threatening and opportunistic infection; therefore, physicians should know the signs and symptoms of the disease so that a timely diagnosis and therapy can be performed.

English

BACKGROUND This study intended to evaluate the prevalence of chronic orofacial pain in diabetic patients and its characteristics. METHODS In this cross-sectional study, 1300 patients referred to the Diabetes Centre of Taleghani Hospital in Kermanshah in 2019 were studied. The data collection tool was a questionnaire including demographic sections, medical history, and clinical findings. Data analysis was performed using SPSS software version 18, and the significance level was considered 0.05. RESULTS The prevalence of chronic orofacial pain in diabetics was 11.8 %. Headaches with a prevalence of 6.7 % were the most common chronic pain, followed by neuropathic pain with 2.54 % and TMJ pain with 2.38 %. The results showed that with an increase in FBS (Fasting Blood Sugar) and HbA1c (Haemoglobin A1c) variables, the prevalence of chronic orofacial pain also increased (P &lt; 0.001). People under 40 and over 60 years were more likely to have TMJ pain (P &lt; 0.001). Also, the duration of pain showed a statistically significant relationship with age and FBS. In patients under 50 years of age, the highest frequency was related to pain persistence less than 30 minutes, and in older ages, the prevalence of pain lasting more than 3 hours was higher (P &lt; 0.02). Also, with an increase in FBS, the duration of pain increased (P &lt; 0.05). The relationship between perceived pain intensity and type of diabetes was significant (P &lt; 0.001). There was also a statistically significant and inverse relationship between pain intensity and age (P &lt; 0.001, ρ = - 0.473). CONCLUSIONS Migraine headaches, chronic neuropathic pain, and TMJ complication have high prevalence in diabetic patients, and management of these pain should be put under consideration by clinicians. KEY WORDS Diabetes, Chronic Orofacial Pain, Prevalence

Psychometric Properties of the Persian Version of Perceptions of Physical Restraint Use Questionnaire

Objectives: One of the fundamental responsibilities of nurses in care is to prevent harm to the patients and others. Many nurses use physical restraints to achieve this goal. Considering that the use of physical restraints in older patients is associated with physical and psychological complications and ethical issues, it is important to identify the nurses’ perceptions of using physical restraint in hospitalized older adults. This study aims to evaluate the psychometric properties of the Persian version of Perception of Physical Restraint Use Questionnaire (PRUQ) to be used in caring for hospitalized older adults in Iran. Methods &amp; Materials: This is a methodological study with a descriptive cross-sectional design that was conducted in hospitals in Kermanshah (Western Iran) in 2019. After obtaining permission from the developers of PRUQ, translation to Persian was performed according to standard protocol of World Health Organization. Then, the Persian version was completed by 330 nurses who were selected by a convenience sampling method based on the inclusion criteria. Then, its face validity and content validity (qualitatively and quantitatively), construct validity using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), test-retest reliability, internal consistency and structural reliability were assessed. Statistical analysis was performed in SPSS v. 23 and AMOS v. 5 applications. Results: Results showed a Content Validity Index (CVR) of 0.78 and a scale CVI of 0.88. Based on the results of EFA and CFA, three factors were extracted including “prevention of fall”, “prevention of interruption or interference in treatment” and “providing safe environment”. The good fit of the three-factor model of the Persian PRUQ was approved based on the model fit indices (Chi square/degree of freedom=2.27, Goodness-of-Fit Index=0.83, Comparative Fit Index =0.91, Normed Fit Index=0.92, Root Mean Square Error of Approximation=0.08). The reliability of the questionnaire was confirmed by Cronbach's alpha coefficient (0.82), structural reliability (&gt;0.70) and intraclass correlation coefficient (0.86). Conclusion: The Persian version of PRUQ has good validity and reliability to be used in nurses working in hospitals in Iran. It can be used in future studies in this population.

Effect of exercise on depression and fatigue in breast cancer women undergoing chemotherapy: A randomized controlled trial

BackgroundDepression and fatigue are common consequences of breast cancer that lead to dysfunction and reduced quality of life of patients. The aim of the present study was to determine the effect of exercise program on depression and fatigue in breast cancer women undergoing chemotherapy. MethodsThis randomized controlled trial study was performed on 60 breast cancer women undergoing chemotherapy in Kermanshah hospitals from 2017-2018. Participants were selected using convenience sampling and were randomly divided into intervention and control groups. Data collection tools included demographic information form and standard Beck depression inventory (BDI-II) and fatigue severity scale (FSS). The intervention group performed the 20-30-minute indoor exercise program 3 sessions a week for 6 weeks. Questionnaires were completed before, immediately, and one month after the intervention by both groups and data analysis was carried out using SPSS ver.22. ResultsThere was no statistically significant difference between the two groups in terms of the mean fatigue intensity and depression scores before the intervention; however, the mean fatigue intensity scores were significantly decreased in the intervention group as compared to the control group immediately and one month after the intervention (P = 0.001). There was no statistically significant difference between the two groups in terms of mean depression score immediately and one month after the intervention (p > 0.05). ConclusionConsidering that indoor exercises reduced fatigue in breast cancer women undergoing chemotherapy, patients are recommended to perform exercise interventions as a non-pharmacological, safe, easy, and non-invasive solution to improve their physiological capacities and functional abilities as well as Quality of life. On the other hand, since exercise program had no effect on depression among breast cancer women in the present study, longer studies with larger sample size are recommended.

A Comparison of Thioredoxin 1 Gene Expression in Schizophrenia Patients before and after Treatment with Risperidone

Background: Schizophrenia is a mental disorder characterized by distortions in thinking, perception, emotions, language, self-sense, and behavior. Recent research suggests that Reactive Oxygen Species (ROS) are involved in the pathophysiology of schizophrenia. Studies have also shown the increased plasma and serum levels of the Trx1 molecule in schizophrenia patients. In the present study, the researchers compared the expression levels of Trx1 mRNA in peripheral blood leukocytes of Iranian schizophrenia patients compared to healthy controls. Methods: First-episode patients (n=35) who met DSM-IV criteria for schizophrenia were recruited from patients referred to psychiatrists in the city of Ilam and Farabi Hospital in Kermanshah. Healthy people were also selected by recruiting people who, according to a psychiatrist, did not have any mental illness. Diagnoses were made for each patient by two independent experienced psychiatrists and confirmed by the Structured Clinical Interview for DSM-IV (SCID). Patients were treated with risperidone for three months and then compared with thirty- five healthy volunteers. Patients were sampled before and after treatment and then by RNA Extraction and DNA synthesis, Trx1 gene expression was performed by real-time PCR method. Results: Comparison of Trx1 gene expression in PBMCs of schizophrenic patients before and after treatment with the control group showed that the expression of Trx1 gene of the “before” treatment group was significantly increased compared with that of the control group (P= 0.0007). Also, Trx1 gene expression in PBMCs of “before” and “after “groups showed that Trx1 gene expression of “after” group was significantly decreased compared to the “before” group (P= 0.014). These results showed that the mean of positive, negative, and general psychopathology was reduced significantly in schizophrenic patients before and after treatment in all three cases (P &lt;0.001). Conclusion: the expression of TRX in PBMCs of schizophrenic patients decreased after risperidone treatment. This reduction of expression was statistically significant and indicates the possible effect of risperidone on the expression of the TRX gene in PBMCs of these patients and decreased gene expression is associated with reduced symptoms. Confirmation of the achievement of this study requires further research. Key words: Schizophrenia, Thioredoxin, Risperidone

The effectiveness of acceptance and commitment therapy on sociooccupational compatibility and acceptance of symptoms in patients with painful Diabetic Neuropathy: A single-blind randomized clinical trial

Introduction: Neuropathic pain is a common complication of diabetic patients. In these people, the pain reduces the work and social adjustment. Aim: The aim of this study was to evaluate the effectiveness of acceptance and commitment therapy on chronic pain acceptance and the work and social adjustment in patients with painful diabetic neuropathy. Method: This study was a quasi-experimental study in which patients were randomly divided into intervention and control groups. Participants were all patients with a diagnosis of diabetic neuropathy referred to the neurology department of Farabi Hospital in Kermanshah in 2019. Instruments included Chronic Pain Acceptance Questionnaire (CPAQ) and the Work and Social Adjustment Scale (WSAS). The results of three phases of pre-test, post-test and follow-up were evaluated. Data were analyzed by descriptive statistics, the repeated measures ANOVA, and chisquare tests using SPSS version 22. Results: The results demonstrate that in the post-test and follow-up phases, acceptance and commitment therapy could improve pain acceptance and the work and social adjustment in the intervention group as compared to controls. In the acceptance variable, the test results within the group showed that the effect of time (P=0.003, F=6.48) and the interactive effect of time and group (P=0.001, F=12.49) were significant. Also in the variables of work and social adjustment, the effect of time (P=0.046, F=3.21) and the interactive effect of time and group (P=0.028, F=3.74) were reported (p&gt;0.001). Conclusion: Acceptance and commitment therapy can be used as a psychological intervention along with drug therapy to improve the work and social adjustment and acceptance symptoms in patients with painful diabetic neuropathy (PDN).

The Effect of oral Administration of Cichorium Intybus on Reduction of Liver Enzymes in Patients with Major Thalassemia: Randomized Clinical Trial Study

Background: Beta-thalassemia is a common hematological disorder. The aim of this study was to determine the effect of oral administration of Cichorium intybus on reduction of liver enzymes in patients with major thalassemia. Materials and Methods: This study was randomized clinical trial study that was conducted on 100 patients with age over 2 years and major thalassemia referred to Mohammad Kermanshahi Hospital of Kermanshah city (Iran) in 2019-2020. Eligible patients were randomly divided into two intervention (n=50), and control (n=50)groups.The intervention group received 0.028mg/kg/day Cichorium intybus as a medicinal supplement and control group received placebo for 3 months. All patients were evaluated and followed up for 6 months. The Liver enzymes levels (AST and ALT) were measured at four time periods (baseline, 1.5, 3 and 6 months after intervention). Ferritin was also measured at three time periods (baseline, 3, and 6 months after the intervention).The SPSS software version 24.0 was used to data analysis. Results: The results of Repeated Measure ANOVA test showed that therewere significant statistical differencebetween the two groups of intervention and control in term of ALT and AST at different time periods, so that the means of ALT and AST after the interventionwere lower in intervention group than control group(p 0.05). Conclusion: Oral administration of Cichorium intybus can reduce liver enzyme levels (ALT and AST) in patients with thalassemia major. Therefore, Chicory administration in patients with major thalassemia is suggested.

The effect of stress inoculation training on existential anxiety and resilience of cancer patients

Cancer is a chronic disease that is spreading day by day. Most people with cancer suffer from a lot of anxiety and stress. With regard to this issue, the present study investigated the effect of group training program for stress-inoculation on existential anxiety and resilience of cancer patients. The study was a randomized clinical trial conducted on 30 people with cancer who referred to Imam Reza Hospital in Kermanshah, Iran. Then they were randomly divided into two groups of intervention and control. The Connor-Davidson Resilience Questionnaire was used to collect information. Before the intervention, both groups completed the questionnaires. Then the intervention group received 8 sessions of 60–90-min stress-inoculation training. At the end of the intervention, both groups completed the research questionnaires immediately and after one month. The data was analyzed using SPSS25. The results showed a significant decrease in existential anxiety (p ≤ 0.001) and an increase in resilience (p ≤ 0.001) after stress-immunization training in the intervention group. During one month of follow-up, the results showed a significant decrease in existential anxiety (p ≤ 0.001), but no significant increase in resilience (p = 0.064). According to the results of this study, group training program for stress-inoculation has reduced the level of existential anxiety and resilience in cancer patients. Therefore, it is recommended that stress-inoculation training be considered in cancer patients. Trial registration: Iranian Registry of Clinical Trials IRCT20130812014333N100. Registered 2018-08-29, https://www.irct.ir/search/result?query=IRCT20130812014333N100

Patients’ Concerns at Their Admission in Hospital and Its Related Factors in Kermanshah, Iran

Background: One of the critical factors affecting patients’ outcomes is their concerns about different issues during their admission to the hospital. Clarifying these concerns and providing appropriate approaches could improve the quality of care, result in better outcomes, and reduce treatment costs. The present study aimed to investigate patients’ concerns during hospitalization, and the likely related factors of the educational hospitals in Kermanshah, western Iran. Materials and Methods: This analytical-descriptive study included 600 adult patients selected via a multi-stage sampling method and admitted to all four educational hospitals affiliated to Kermanshah University of Medical Sciences )KUMS) in 2016. Required data were collected using a survey with 15 questions on demographic information, current disease, medical records, and a researcher-developed questionnaire on factors causing concern in the Likert scale. Results: Of 600 patients who participated in the survey, 336 (56%) were female and 486 )81%) were married. The most frequent concerns were the length of admission, failure in treatment or recovery, and hospital costs, respectively. The length of hospital stay, income, and level of education were significantly associated with the concern scores. Also, there was a significant difference between concern score distributions in groups with a definite diagnosis of illnesses (P&lt;0.05). Conclusion: The results of this study suggested a correlation between variables such as education, income, the final diagnosis of a sickness, and the concern level of admitted patients. Our findings could help managers and hospital administrators better understand the concerns of admitted patients and find solutions to remove them.

The Prevalence and Pattern of Enterobacter Antibiotic Resistance in the Patients Admitted to Imam Reza Hospital in Kermanshah, Iran (2016 - 2018)

Background: Antibiotic resistance is spreading worldwide against the Gram-negative bacteria that cause nosocomial infections. Objectives: The present study aimed to determine the antibiotic resistance pattern of Enterobacter isolated from the blood, urine, wound, and sputum samples of the patients referring to Imam Reza Hospital in Kermanshah, Iran. Methods: This descriptive, cross-sectional study was conducted on 649 patients with positive Enterobacter cultures at Imam Reza Hospital during 2016 - 2018. The isolates were obtained using laboratory tests based on the CLSI protocol. In addition, the standard disc-diffusion method was used to assess antibiotic susceptibility. Data analysis was performed in SPSS version 20. Results: Most cases of positive Enterobacteriaceae were isolated from the patients admitted to the intensive care unit (35.6%) and emergency ward (21.9%), as well as the urine (51.6%) and sputum samples (20.5%), respectively. Levofloxacin, ciprofloxacin, and imipenem were the most effective antibiotics against Enterobacter with the susceptibility of 56.7%, 54.8%, and 53.3%, respectively. Conclusions: According to the results, the antibiotic resistance of Enterobacter to ampicillin and ceftriaxone was high, and these antibiotics must be used correctly and reasonably. Furthermore, more epidemiological studies are required in Iran to provide national programs for preventing the spread of antibiotic resistance.