Teaching Hospitals In Isfahan Research Articles

Iranian nurses’ preparation for loss: finding a balance in end‐of‐life care

To explore the nurse-patient interaction in terminally ill situations in acute care, focusing on the nurses' preparation for loss. Caring for dying patients can be a distressing and sometimes even threatening experience for nurses. Despite the vast body of literature on nurse/patient interaction and the quality of end-of-life care, few studies focus specifically on nurses' experience. A grounded theory approach was used to explore nurses' interaction with dying patients and their families and examine how nurses deal with situations in which the patient's death is inevitable. Eighteen nurses were interviewed up to three times each at three teaching hospitals in Isfahan, Iran, during autumn 2006. A shortlist of possible participants was obtained by means of theoretical sampling and those who had experienced the death of patients and were able to express their feelings verbally were selected. The results clarified a core consideration: striking a balance between restorative and palliative care, information and hope, expectations and abilities and intimacy and distance. Attaining a balance in caring for dying patients is a major challenge to nurses: it concerns not only their interactions with patients and their families, but also their perceptions of themselves and their actions in end-of-life care. In end-of-life care, it is important for nurses to be able to change the focus of their care when the patient's condition is diagnosed as irreversible. They also need to be well equipped to maintain a balance, thereby preparing themselves for the patient's forthcoming death.

Iodine repletion, thyrotoxicosis and atrial fibrillation in Isfahan, Iran.

BackgroundIodized salt was reintroduced in Iran in 1989. Just before distribution of iodized salt thyrotoxicosis was observed in 3.7% of the patients with atrial fibrillation (AF) in university teaching hospitals in Isfahan, a centrally located city in Iran. As repletion of iodine may increase the rate of autoimmune thyroid diseases and toxic multinodular goiter, this study was designed to evaluate the rate of thyrotoxicosis in patients with AF in the same hospitals after about a decade of iodized salt consumption.MethodsIn a case-control study with convenience sampling, 100 patients with AF and an equal number of age- and sex-matched subjects taking the same medications were selected as case and control groups, respectively, in university hospitals in 1997.ResultsEight percent of patients with atrial fibrillation had overt thyrotoxicosis versus one percent in the control group (odds ratio=8.6, 95% CI= 6.5 to 10.7, P<0.02). Thyrotoxicosis in patients with AF was 8 times higher than in the control group without AF. In comparison with the period before use of iodized salt, AF more than doubled (8% vs. 3.7%).ConclusionThyroid function should be evaluated in all patients older than 40 years of age with AF. The benefits of iodine supplementation are great, but more attention should be paid to the complications of iodine repletion, including thyrotoxicosis and its frequent accompaniment, AF.

Glucose-6-phosphate dehydrogenase deficiency in neonates.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an inherited deficiency that may be the cause of neonatal hyperbilirubinemia, as has been found in several countries and among widely different ethnic groups, especially in Mediterranean region. Our aim was to study the prevalence of G6PD deficiency in relation to neonatal jaundice. From March 1998 to April 2001 we studied 705 clinically icteric neonates who were admitted to Al-Zahra and Beheshti hospitals, two teaching hospitals in Isfahan, Iran. Laboratory investigations included determination of direct and indirect serum bilirubin concentrations, blood group typing, direct coomb's test, hemoglobin, blood smear, reticulocyte count and G6PD level. In only 53 (7.5%) of cases G6PD deficiency was diagnosed. In all G6PD deficient neonates no evidence of other factors known to cause hyperbilirubinemia were detected. The sex distribution was 13 (24.5%) females and 40 (75.5%) males in the G6PD deficient group. The mean bilirubin level in G6PD deficient and G6PD normal groups were 22.26 +/- 8.36 and 18.14 +/- 3.85 mg/dl, respectively (p=0.001). Phototherapy was required in G6PD deficient and other icteric neonates with duration of 3.76 +/- 1.93 and 3.13 +/- 2.14 days, respectively (p=0.045). Twenty-seven of the 53 (50.9%) G6PD deficient infants required exchange transfusion. None of them developed kernicterus. Since the prevalence of severe hyperbilirubinemia among our neonates was relatively high and about half of them required exchange transfusion, early detection of this enzymopathy regardless of sex and close surveillance of the affected newborns may be important in reducing the risk of severe hyperbilirubinemia and exchange transfusion.