SD Total Score Research Articles

Use of Esketamine Nasal Spray in Patients with Treatment‐Resistant Depression in Routine Practice: A Real‐World French Study

Background. The efficacy and safety of esketamine nasal spray (ESK) were established in registration trials in patients with treatment‐resistant depression (TRD). This French real‐world study aimed to describe the treatment patterns, effectiveness, and safety of ESK in TRD patients over a 12‐month follow‐up. Materials and Methods. This study used secondary data from patient files of hospital‐based psychiatrists and started during the first French patient early access to ESK. The response and remission rates with ESK were analyzed using the total score of the Montgomery–Åsberg Depression Rating Scale (MADRS). The time to first treatment response and work resumption were described (Kaplan–Meier method). Adverse events (AEs) were analyzed. Results. Prior to ESK initiation, the 157 analyzed patients (age ≤ 65 years, 82.8%; female, 66.2%) had depression for 10.5 years (median, IQR, 4.2–21.2) and received a median of 6 (3–8) previous treatment lines. At ESK initiation, the mean ± SD total MADRS score was 32.1 ± 7.7. At that time, ESK was combined with antidepressants (93.6% of patients; SNRI, 65.0%; SSRI, 57.3%) and/or other potentiation strategy (63.1%; atypical antipsychotics, 36.3%; lithium, 25.6%; antiepileptics, 21.7%). During the 12‐month follow‐up, 125 patients (79.6%) discontinued ESK. The median duration of ESK treatment was 19.4 weeks (IQR, 4.4–40.1). At 1 month after ESK initiation, 40.2% of still treated patients met criteria for clinical response and 19.7% for remission (median time to response, 5.7 weeks; 95% CI (4.1–8.4)). 82.6% of active patients were on sick leave at ESK initiation; the work resumption rate was 24% (13%–40%) 12 weeks later. AEs were reported in 68.6% of patients, serious AEs in 17.2%, and AEs leading to ESK discontinuation in 14.6%. Conclusion. These real‐world effectiveness and safety data were consistent with findings from previous clinical trials, describing the real‐life clinical experience of patients receiving ESK and confirming that ESK has its place in therapy for the treatment of TRD.

Abstract P610: French Canadian Translation and Validation of the Eating in the Absence of Hunger Questionnaire for Children and Adolescents

Background: Eating in the absence of hunger (EAH), i.e. eating past the point of satiety, has been associated with the development of excess body weight during childhood, independently of other traditional risk factors. EAH is typically assessed with a laboratory-based standardized protocol which is time-consuming and requires important resources. A questionnaire has been developed to simplify the assessment of EAH among children and adolescents, but it has only been validated in English. Objective: Our aim was to validate a French translation of the EAH Questionnaire among children and adolescents in Montreal, Canada. Methods: Participants aged 7 to 15 years old completed the questionnaire upon recruitment (n=200) and ~4 weeks later (n=159 of 200, 80% of participants). Self-reported body weight and height data was also collected at inclusion and body mass index (BMI) z-scores were computed. The questionnaire includes 14 items divided into three subscales evaluating specific triggers of EAH (fatigue/boredom, negative affect and external cues). The global score for EAH ranges from 14 to 70 points, a higher score indicating a higher tendency to EAH. We assessed internal consistency for the full questionnaire and for each subscale using Cronbach alpha coefficients using data from the first completion of the questionnaire. Temporal stability was evaluated with Pearson correlations between the initial and second completions of the questionnaire, for each of the EAH subscales and for the total score. Association of EAH and BMI z-score was also assessed with Pearson correlation. Results: Participants (50% girls, 100 of 200; 71% white, 142 of 200) were 11.9 ± 2.3 years old, had a mean ±SD total score for EAH of 27.2 ± 9.1 points and a mean ±SD BMI z-score of 0.21 ± 1.05. The total EAH score and the negative affect subscale showed good internal consistency (Cronbach alpha = 0.88 and 0.86, respectively), while internal consistency for the fatigue/boredom and the external cues subscales was considered adequate (Cronbach alpha = 0.75 and 0.68, respectively). The total score and each subscale scores from the second completion of the questionnaire were significantly correlated with their respective scores from the first completion (r = 0.75; ρ < 0.001 for the total score and r = 0.55 to 0.78; ρ < 0.001 for the three subscales). Moreover, participants’ BMI z-score was positively correlated with EAH total score (r = 0.15; ρ = 0.03). Conclusion: A French translated version of the EAH questionnaire appears to represent an adequate and reliable tool to assess EAH among French-speaking Canadian children and adolescents.

Influence of Religious Affiliations on Attitudes Toward Homosexuality Among Physicians: A Cross-Sectional Study From India.

Objective: To examine the attitudes among practicing physicians of various specialties toward homosexuality and its association with participants’ religious affiliations in India. Methods: A cross-sectional descriptive study was conducted among physicians about their attitudes toward homosexuality between December 2018 and January 2019. Participants completed a survey anonymously in hardcopy form or online. The survey was developed based on the Attitude Toward Homosexuality Scale for Indians (AHSI). A higher AHSI score indicates less homonegativity. It was modified by adding demographic details, career status, and personal experience with homosexual individuals. Results: The study results showed that among 106 respondents, 81 were men with a mean (SD) age of 32.2 (7.3) years. Of the participants, 40 (37.7%) were MBBS graduates with no specialization, while 34 (32.1%) and 32 (30.2%) respondents were from medical and surgical specialties, respectively. The majority of the respondents were Muslim (43.4%), followed by Hindu (35.8%), Christian (10.4%), those not conforming to any religion (5.7%), and other religions (4.7%). The mean ± SD total score on the AHSI was 69.6 ± 17.7, which was higher than the mean neutral score of 60. The AHSI total score was significantly higher among women (P < .001). The total AHSI score was highest among the no religion category followed by Hindus, with the lowest for biblical religions; the difference was statistically significant (P < .001). No significant difference was seen between Muslims and Christians. Conclusions: This study showed an overall positive attitude among the respondents toward homosexuality; however, those belonging to Abrahamic religions, especially Muslims, had more negative attitudes. The results highlight the need for antistigma campaigns and educational interventions targeting the physician population of India to reduce negative attitudes toward homosexuality and improve their knowledge of this topic.

Nursing Journal Club as a Tool to Facilitate Evidence-Based Practice: Participant’s Feedback

"Background and aim: Nursing journal clubs have a proven value in nursing education and continuing education, which has expanded widely in the promotion of evidence-based clinical care in recent years. This study aimed to evaluate the clinical nursing journal clubs from the viewpoints of nurses. Methods: This descriptive study was conducted from July 2019- October 2020. This study was conducted in two phases, consisting of designing the format and flowchart and implementing nursing journal clubs and the second phase was evaluation. Results: Format and executive flowchart prepared by the research team and reviewed and approved in the group. In terms of evaluation, minimum (33) and maximum (165) scores with a mean± SD total score of 123.49 ± 19.91 calculated for nursing journal clubs indicate an optimum quality. Conclusions: The qualities of nursing journal clubs were evaluated to be favorable. Accordingly, authorities and planners should consider appropriate actions to facilitate Nursing journal clubs, such as credit points in rank promotion for faculty members, and inclusive in continuing education privileges for nurses, to adapt these activities to the roles of the clinical faculty and the benefits of this educational method in nursing. "

Use of a Novel Clinical Decision-Making Tool in Vestibular Schwannoma Treatment.

To determine the usefulness of a personalized tool and its effect on the decision-making process for those with vestibular schwannoma (VS). Prospective study. Single institution, academic tertiary care lateral skull base surgery program. Patients diagnosed with VS. A comprehensive clinical decision support (CDS) tool was constructed from a previously published retrospective patient-reported data obtained from members of the Acoustic Neuroma Association from January to March 2017. Demographic, tumor, and treatment modality data, including associated side effects, were collected for 775 patients and integrated in an interactive and personalized web-based tool. Pre- and posttool questionnaires assessing the process of deciding treatment for VS using a decisional conflict scale (DCS) and satisfaction with decision (SWD) scale were compared. A pilot study of 33 patients evaluated at a single institution tertiary care center with mean ± SD age of 63.9 ± 13.5 years and with average tumor size of 7.11 ± 4.75 mm were surveyed. CDS implementation resulted in a mean ± SD total DCS score decrease from 43.6 ± 15.5 to 37.6 ± 16.4 ( p < 0.01) and total SWD score increase from 82.8 ± 16.1 to 86.2 ± 14.4 ( p = 0.04), indicating a significant decrease in decisional conflict and increase in satisfaction. Implementing a decision-making tool after diagnosis of VS reduced decisional conflict and improved satisfaction with decision. Patients considered the tool to be an aid to their medical knowledge, further improving their comfort and understanding of their treatment options. These findings provide a basis for developing predictive tools that will assist patients in making informed medical decisions in the future.

Nutrition impact symptoms and the risk of malnutrition in people with Parkinson's disease: A cross-sectional study.

People with Parkinson's disease (PD) often experience symptoms that affect their ability to eat. This may contribute to weight loss and increased risk of malnutrition. The present study aimed to quantify the extent of nutrition impact symptoms (NIS) in the population and a scoring system of NIS was incorporated in the tool used to identify malnutrition. In this cross-sectional study, members of the Norwegian Parkinson's Association, with any PD diagnosis and stage of illness, were invited to respond to an online 24-item questionnaire. Questions from two validated questionnaires, comprising the abridged Patient-Generated Subjective Global Assessment (aPG-SGA) and the Radboud Oral Motor Inventory for Parkinson's disease (ROMP), were adapted to an online format. The questionnaire was sent to 3047 members, of which 508 persons (17%) responded (61% men). In total, 59% were categorised as well-nourished, 34% at risk of malnutrition and 6.5% as malnourished. One quarter of all participants reported symptoms that affected food intake. The most frequent symptoms were constipation (14.2%) and dry mouth (13.4%). Malnourished participants reported a mean ± SD of 3.4 ± 1.4 symptoms versus 0.1 ± 0.3 per well-nourished participant. Malnourished participants had more swallowing problems than well-nourished participants, with a mean ± SD total ROMP score of 15.5 ± 6.0 versus 9.0 ± 2.9 (p < 0.001). As the number of points in the ROMP score increased by one, the points in the aPG-SGA score increased with 37% (95% confidence interval = 0.309-0.428). Risk of malnutrition was largely related to NIS, especially dysphagia in people with PD. Symptoms affecting food intake should be systematically mapped and treated in conjunction with PD to prevent malnutrition.

Effect of an Online Educational Intervention on Resilience and Care Burden of the Parents of Children With Cancer

Background &amp; Aims: Most parents of children with cancer experience a care burden. Increasing their resilience can help reduce their care burden. This study aims to determine the effect of online resilience educational intervention on the resilience and care burden of parents of children with cancer. Materials &amp; Methods: This is a single-group study with a pre-test/post-test design. Fifty parents of children with cancer referred to selected medical centers in Tehran, Iran were selected using a continuous sampling method from July 2020 to February 2021 . The data collection tools were a demographic form, Connor-Davidson resilience scale and Novak and Guest’s caregiver burden inventory. Resilience education was presented for 4 weeks online. One month after the intervention, post-test assessments were conducted. Data analysis was done using descriptive and inferential statistics (paired t-test) in SPSS software, version 26 software. Results: The Mean±SD resilience score before the intervention was 50.32±21.84 and increased to 78.24±9.16 after the intervention (P&lt;0.001). The Mean±SD total score of care burden before the intervention was 57.18±18.17 and reduced to 24.02±7.45 after the intervention (P&lt;0.001). Conclusion: The online resilience educational program can increase the resilience and reduce the care burden of the parents of children with cancer. It can be used by nursing managers to increase resilience and reduce the care burden of these parents.

Safety and Efficacy of Burosumab in Pediatric Patients With X-Linked Hypophosphatemia: A Phase 3/4 Open-Label Trial.

ObjectiveBurosumab, an anti-fibroblast growth factor 23 antibody, was recently approved for the treatment of X-linked hypophosphatemia (XLH).We evaluated the safety and efficacy of burosumab in pediatric XLH patients.MethodsThis open-label, phase 3/4 trial of ≤ 124 weeks’ duration was conducted at 4 Japanese medical centers. Fifteen children aged 1 to 12 years with XLH were included. All had previously been treated with phosphorus or vitamin D. Subcutaneous burosumab was administered every 2 weeks, starting with 0.8 mg/kg, and adjusted based on serum phosphorus levels and any safety concerns (maximum 2 mg/kg). Safety assessments included the frequency of treatment-emergent adverse events (TEAEs). Efficacy of burosumab on biochemical markers, clinical markers of rickets, motor function, and growth was also evaluated.ResultsThe average treatment duration was 121.7 weeks. Frequently reported TEAEs were nasopharyngitis (46.7%), dental caries (40.0%), and influenza (33.3%). At baseline, patients had low serum phosphorus concentrations (2.6 ± 0.3 mg/dL) and low-to-normal 1,25-dihydroxyvitamin D concentrations (24.7 ± 12.7 pg/mL), which increased with burosumab treatment and were maintained during the study period. Alkaline phosphatase decreased continuously. At baseline, the mean ± SD total Thacher Rickets Severity Score (RSS) was 1.3 ± 1.2, and 4 patients (26.7%) had an RSS ≥ 2.0. Mean Radiographic Global Impression of Change and RSS tended to improve, particularly in patients with higher baseline RSS. There was a trend toward increased 6-minute walk test distance. No apparent changes in growth rate were observed.ConclusionBurosumab has a good safety profile and is effective in pediatric patients with XLH.

PuraStat RADA16 Self-Assembling Peptide Reduces Postoperative Abdominal Adhesion Formation in a Rabbit Cecal Sidewall Injury Model

Objective: To evaluate the effect of PuraStat (2.5% RADA16) administration on postoperative abdominal adhesion formation in an in vivo model. Methods: Anesthetized New Zealand white rabbits underwent cecal sidewall abrasion surgery in which the cecal serosa and juxtaposed parietal peritoneum were abraded after access through an abdominal midline incision. Eight animals were randomized to receive PuraStat administration at the interface of the injured tissues before incision closure, and five animals served as untreated controls. Treated animals received 3–12 ml PuraStat solution per lesion. Animals were sacrificed 14 days after surgery and examined for adhesion formation at the wound site. Results: At study terminus, adhesions were identified in 90% (9/10) of abraded cecum/peritoneal wound sites in untreated controls versus 25% (4/16) of PuraStat-treated sites (p = 0.004). Mean ± SD Total Adhesion Score (average of the values for extent + strength of the adhesion in both defects per animal; maximum score = 14 points) was significantly 76% lower in PuraStat-treated animals (2.0 ± 3.0 points) compared to untreated controls (8.2 ± 1.9 points) (p = 0.029). Mean adhesion coverage area of wound sites was 79% lower in PuraStat-treated animals than controls (p < 0.001), and mean adhesion durability was 72% lower in PuraStat-treated animals versus controls (p = 0.005). Remnant hydrogel was observed at the wound sites of 75% of treated animals at postoperative Day 14. Conclusion: PuraStat treatment has a positive protective effect in the cecal sidewall injury model, and significantly reduces abdominal adhesion formation at the interface of the injured cecum and overlying peritoneal sidewall defect.

Nursing Students’ Performance and Satisfaction Regarding the Classification of Pressure Injuries Using Simulation With Moulage

Background: Simulation-based education is a widely utilized tool for experiential learning in nursing education. The aim of this study was to determine nursing students’ performance and satisfaction in the classification of pressure injuries using simulation with moulage. Methods: It is an evaluation study with a quasi-experimental, single-group, post-test design that was conducted in the spring semester of the 2019-2020 academic year in the Nursing Department of the Faculty of Health Sciences of Izmir Katip Celebi University, Izmir, Turkey. In total, 66 final-year nursing students, voluntarily participated in the Assessment of Pressure Injury Course. A student characteristics form, a Pressure Injury Classification Form, and a Moulage Satisfaction and Evaluation Form were used as data collection tools. Data were entered into SPSS v. 21, and the results of the analysis were described using descriptive statistics. Results: It was found that 67.2% (n=45) of the students correctly assessed all the stages of pressure injury moulages on the standardized patients. Among the students, 62.1% (n=41) strongly agreed that their assessment skills of pressure injury improved after the simulation. The results related to students’ satisfaction indicated that 77.3% (n=51) of the students evaluated the moulages as realistic. The Mean±SD total score of students’ evaluation of moulage simulation sessions on standard patients was 4.56±0.59 (range=1-5). Conclusion: This moulage is a simple, easily accessible, low-cost, and effective tool for teaching pressure injury assessment to nursing students. It can be used in clinical skills training and clinical assessment in nursing education.

Impact of brief educational intervention on knowledge of cancer among community pharmacists.

Community pharmacists may play a vital role in early detection and prevention of cancer. Findings from our pre-assessment studies showed that the Ghanaian community have inadequate knowledge of cancer. We assessed the impact of a brief educational intervention on knowledge level of cancer among Ghanaian community pharmacists. The study was a descriptive interventional study. Knowledge of cancer, signs and symptoms, risk factors and cancer screening tests were assessed before in a pre-assessment study and after a brief online education in our current study. A total of 435 community pharmacists were recruited in both studies. The mean ± SD total knowledge score of cancer increased from 9.03 ± 2.65 to 12.97 ± 1.43 out of a maximum score of 15 points. The mean ± SD total knowledge score of signs and symptoms of cancer increased from 4.15 ± 2.14 to 6.86 ± 0.76 out of a maximum score of 7 points. For the total knowledge score of causes and risk factors of cancer, the mean ± SD score increased from 8.13 ± 3.31 to 11.59 ± 0.87 out of a maximum score of 12 points. Lastly, the mean ± SD total knowledge score of cancer screening tests increased from 9.04 ± 5.01 to 16.39 ± 0.86 out of a maximum score of 18 points. There were overall statistically significant improvements of participants knowledge in all aspects of cancer in this study compared to the pre-assessment study. Our study presents evidence of the effectiveness of a brief educational intervention tailor-made for Ghanaian community pharmacists.

The Relationship Between Social Support and Postpartum Depression

Introduction: Postpartum depression is a common and severe problem that has adverse effects on maternal and family health. Social support is one of the determinants of health, and in recent years has received increasing attention, and its overlook is a significant risk factor for postpartum depression. Objective: This study aimed to determine the relationship between social support and postpartum depression in women referring to comprehensive health centers in Rasht City, Iran. Materials and Methods: The present study is a cross-sectional, analytical study performed on 300 mothers referred to the comprehensive health service centers in Rasht 2-4 weeks after their deliveries. They were selected by cluster sampling method, which was done systematically within each cluster. The study data were collected using a three-part questionnaire of demographic characteristics, Edinburgh Postpartum Depression Scale (EPDS), and Hopkins social support. The obtained data were analyzed using descriptive and inferential statistics (t-test, Friedman, Mann-Whitney, Kruskal-Wallis, Spearman correlation coefficient, and rank logistic regression). Results: The results showed that the mean±SD age of the study mothers was 29±5.3 years. About 63.7% of mothers had low postpartum depression, and their mean±SD total score of social support was 64.03±16.92. The most support received from the spauses and parents. There was a statistically significant relationship between social support received by mothers after childbirth with education level (P=0.003), job (P=0.001), spauses’ job (P=0.001), income (P=0.001), residence status (P=0.043), number of deliveries (P=0.05) and pregnancy desire (P=0.047) and there was a significant inverse correlation between depression score and social support score by spauses (P=0.004, r=-0.167), parents (P=0.002, r=-0.176) and total social support score (P=0.024, r =-0.130). After adjusting for individual social variables, the effect of social support score on the part of the spauses (P=0.001), parents (P=0.006), friends, and relatives (P=0.033) continued to be associated with the severity of depression. Also, the number of deliveries (P=0.05) and h spauses’ jobs (self-employed) were significant compared to the unemployed ones (P=0.049). Conclusion: The results showed a significant and inverse relationship between social support and symptoms of postpartum depression. Although these results show the most support from spauses and parents, the amount of support received in the area of spauses’ ​​parents, friends, and relatives were low. It is necessary to draw the attention of midwives and health care providers to mothers and inform them about the importance of social support and its prominent role in reducing postpartum depression.

Resilience in the face of pelvic pain: A pilot study in males and females affected by urologic chronic pelvic pain.

AimsResilience represents a fundamental element in the experience of pain, as it allows adaptation to suffering and increases psychological social well‐being and quality of life (QoL). We investigated resilience in patients affected by urologic chronic pelvic pain (UCPP) and the relationships with pain severity and distribution, catastrophizing and psychological distress.MethodsForty‐eight consecutive UCPP patients were classified on a pain body map as being affected by pelvic pain only or widespread pain (WP), and underwent the evaluation of resilience with the 14‐item Resilience Scale (RS‐14), with higher scores indicating high resilience levels; scores < 56 denote very poor resilience. Pelvic and nonpelvic pain intensity and the bother of urinary symptoms on QoL were measured by means of Pain Numerical Rating Scale (PNRS) and Visual Analog Scale (VAS). Pain Catastrophizing Scale (PCS) and Depression Anxiety Stress Scales (DASS‐21) investigated catastrophizing and psychological conditions.ResultsOverall, RS‐14 mean ± SD total score was 50.2 ± 12.5 in patients with pelvic pain only and 40.2 ± 10.2 in those with WP. Significant relationships were observed between low resilience levels and high scores of pelvic and nonpelvic PNRS, VAS, pain catastrophizing scale and depression and anxiety, stress scale (for all: p < 0.001). Significantly lower RS‐14 scores were detected in females and in patients with WP.ConclusionsA very poor resilience has been identified in UCPP patients, particularly in those with greater catastrophizing and mood alterations. WP and female gender were mostly affected. In UCPP patients, low resilience appears as a crucial factor in pain experience.

Depression Literacy Among Dermatologists: An Online Survey Study in India.

Early and higher detection rates of depression among dermatology patients can lead to better prognosis. Increased depression literacy among dermatologists might play a vital role in the early and successful detection and treatment of depression among their patients. The objective of this study was to investigate depression literacy among dermatologists working in India. An online survey with a questionnaire comprising sociodemographic variables and the Depression Literacy Questionnaire was conducted to collect data on depression literacy among dermatologists between July 6, 2019, and August 6, 2019. Sociodemographic variables included age, sex, educational qualification, practice location, practice duration, and practice type. The response rate was 56.99%. The majority of respondents were aged 31-50 years, female, and working in urban areas. The mean ± SD total score of the respondents was 17.4 ± 2.36, with the lowest score being 10 and the highest score 22. More correct answers (98.1%) were recorded for the items "loss of confidence and poor self-esteem may be symptoms of depression" and "sleeping too much or too little may be sign of depression." The mean total score of female respondents was higher than that of men, and the difference was significant (P = .003). The study revealed good depression literacy status among dermatologists working in India. Female respondents were found to have higher depression literacy.

Dissociation, Stressors, and Coping in Patients of Psychogenic Nonepileptic Seizures.

Background:Psychogenic nonepileptic seizures (PNES) commonly present both to neurologists and psychiatrists and include a wide range of psychopathology. In order to understand the demographics, dissociative experiences, stressful life events, abuse, and coping in these patients, this study was undertaken.Methods:This was a cross-sectional, observational study. A total of 71 patients of PNES, referred from neurology, were assessed on Dissociative Experience Scale (DES), Scale For Trauma and Abuse, Presumptive Stressful Life Events Scale (PSLES), and Ways of Coping Questionnaire to ascertain the dissociative experiences; the prevalence of trauma, abuse, and stressful life events, and the coping mechanisms.Results:Females predominated, with the duration of PNES up to 2 years. The mean ± SD total DES score was 38.14 ± 14.1, indicating high dissociation. On the PSLES, for the stressful life events in the last one year, the mean score was 98.28 ± 87.1. Marital and family conflicts and death were reported more. History of childhood or adult physical and sexual abuse was less reported. History of head trauma was present in 13 patients. Emotion-focused coping was used more than problem-solving strategies.Conclusions:Very few Indian studies have looked into these nuances. This study has helped in improving the understanding of the various risk factors of PNES and the coping strategies, and in sensitizing psychiatrists and neurologists to enquire into trauma and abuse of these patients.

Informal caregiver burden and influencing factors in gynaecological oncology patients hospitalized for chemotherapy: a cross-sectional study.

ObjectiveTo determine the level and influencing factors of informal caregiver burden in gynaecological oncology inpatients receiving chemotherapy.MethodsThis cross-sectional study enrolled gynaecological oncology patients and their informal caregivers between May 2018 and November 2018 and measured the caregivers’ burden using the Caregiver Burden Inventory. The influencing factors were evaluated with univariate regression analysis and multivariate linear stepwise regression analysis.ResultsA total of 138 patients and their informal caregivers completed the questionnaire. The mean ± SD total informal caregiver burden score was 53.18 ± 10.97. The highest mean ± SD score was recorded in the dimension of time-dependent burden (14.28 ± 2.74), followed by developmental burden (13.65 ± 2.15), physical burden (10.52 ± 2.07), social burden (7.61 ± 2.58) and emotional burden (7.12 ± 1.43). Multivariate analysis showed that the informal caregiver’s sex, relationship to the patient, daily duration of care, presence of chronic health problems and the duration of the patient’s disease were factors influencing the level of caregiver burden.ConclusionsThe informal caregivers of gynaecological cancer patients hospitalized for chemotherapy experience a moderate level of burden. Nursing measures should be considered to reduce informal caregiver burden and improve the quality of lives of both patients and their caregivers.

Health Promoting Lifestyle and its Relationship with Self-Efficacy in Iranian Mastectomized Women.

Introduction:Lifestyle modification has an important role in long-term health of breast cancer patients. As a result, this study aimed to identify the health-promoting lifestyle and its subdomains in mastectomized women and its relationship with self-efficacy. Materials and Methods:This cross-sectional study investigated 100 mastectomized women in Tabriz-Iran, 2018. The participants were selected using the convenience sampling method. Data was collected using a sociodemographic questionnaire, the Health Promoting Lifestyle Profile II (HPLP-II), and the General Self-Efficacy Scale by Sherer. The multivariate general linear model with adjusting the sociodemographic variables was used to determine the relationship of the health-promoting lifestyle with self-efficacy. Results:The mean±SD total score of the health-promoting behaviors was 135.5±16.7 from the obtainable score of 52 to 208. The highest and lowest mean scores were observed in the spiritual growth (25.4±4.3) and physical activity (15.2±4.4), respectively. The mean±SD self-efficacy score in this study was 57.3±7.4 from the obtainable score of 17 to 85. There was a significant positive correlation between the total score of the health-promoting lifestyle (r= 0.369; p<0.001) with self-efficacy. Results from the adjusted general linear model showed that the age, educational attainment of the spouse, and self-efficacy were the health-promoting lifestyle predictors. Conclusion:The findings of this study indicate the importance of self-efficacy and modifiable variables such as education in the engagement of mastectomized women in the health-promoting lifestyle. Regarding the positive relationship of self-efficacy with the health-promoting lifestyle, it seems that the interventional attempts to improve self-efficacy in these patients especially with considering the variables of age and spouse’s educational level can contribute to the improvement of the health-promoting lifestyle.

Development and Validation of a Novel Surgical Simulation for Parotidectomy and Facial Nerve Dissection.

We present the development and validation of a low-cost novel model for training of parotid surgery. The model consists of a 3-dimensionally printed skeleton, silicone-based soft tissue, and facial nerve replicated with copper wire, circuited to indicate contact with instruments. The face validity of the simulator was evaluated with a 21-item 5-point Likert survey. Content validity was evaluated through a survey completed by the trainees after their first live parotidectomy following the simulation. Twelve residents and 6 faculty completed the simulated procedure of superficial parotidectomy after watching a video demonstration. Completion of 16 surgical steps evaluated by this model was graded for each participant. The mean ± SD total assessment score for faculty was 15.83 ± 0.41, as compared with 13.33 ± 2.06 for residents (P = .0081). The simulator as a training tool was well received by both faculty and residents (5 vs 4, P = .0206). Participants strongly agreed that junior residents would benefits from use of the model.

Treatment-resistant obsessive compulsive disorder: New generation antipsychotics as supplemental drugs for assuagement of intractable symptoms

Introduction: About half of patients with obsessive-compulsive disorder don’t respond appropriately to serotonin-Reuptake inhibitors. Hence, the objective of the present study was to examine that whether using olanzapine, as augmentative medication, in addition to current serotonin reuptake inhibitor, is useful for treatment-resistant obsessive-compulsive disorder. Method: Eleven patients with obsessive compulsive disorder who had not responded appropriately to at least two preceding treatments with serotonin reuptake inhibitors had been assigned to receive olanzapine, in addition to serotonin reuptake inhibitor, for eight weeks, in an open-label design evaluation. Response, as well, had been evaluated by Yale-Brown Obsessive-Compulsive Scale (YBOCS), as the primary outcome measure. Results: Around fifty four percent of patients responded to abovementioned maneuver. The mean+/-SD total score of YBOCS reduced significantly from 33.45 +/- 4.47 to 25 +/- 5.98, with a mean reduction of 24.56%. Conclusion: Adding olanzapine to serotonin-reuptake inhibitors can be useful in treatment-refractory obsessive-compulsive disorder.

Objective structured clinical examination versus traditional clinical examination among nursing students: A comparative approach

The complex nature of clinical competence in nursing consequently poses a challenge in identifying suitable assessment methods that are able to measure all its attributes as well as maintaining reliability, validity and objectivity. So the aim of this study was to compare nursing students’ opinions, feedback and clinical achievements grades in the Objective Structured Clinical Examination (OSCE) and the Traditional Clinical Examination (TCE) methods. A descriptive research design was used to conduct the study at college of nursing –Immam Abdulrahman Bin Faisal University (IABU), kingdom of Saudi Arabia. A total of 96 undergraduate student nurses enrolled in the pediatric nursing course equally were divided randomly into TCE and OSCE group (n = 48) in each group. Two tools were used, first tool was a structured questionnaire form to collect data related student’s academic number, age, method of exam used, achievement grades in the exam and the overall suggestions to improve the method of exam used where the second tool was a self-administered questionnaire that modified from a Pierre et al. (2004) OSCE feedback questionnaire which included 23 items and categorized under four main dimensions with 3-point Likert scale ranged from agree, neutral and disagree to evaluate students’ opinions and feedback related to the quality, organization, scoring and physical set up of both methods. Results revealed that statistical significant differences were found with higher prevalence of agreement responses among students for OSCE methods related most of items listed in the four dimensions compared to those in TCE. Mean ± SD total score of students’ responses related to OSCE and TCE methods was 104.5 ± 15.6 and 95.3 ± 17.5 respectively where p value = .002. Majority of students 95.8% exposed to OSCE compared to 11.9% of them who exposed to the TCE achieved (A) excellent grades in the exam (score 90%-100%). Conclusion and recommendation, statistical significant differences were observed between students’ opinion and feedback with high prevalence of agreement responses related to OSCE compared to TCE methods. Clinical achievement grade was high among students whom evaluated by OSCE compared to those evaluated by TCE method. The study recommended that OSCE must be used as an integral part of the under graduate nursing students’ clinical assessment.