Background: Quality improvement in delivering healthcare services is the main mission of every health system. Safe surgery checklist was introduced by World Health Organization (WHO), and hospitals were required to use it to reduce the risk of surgery-related mortality and morbidity. This study aimed to determine study hospitals’ compliance with safe surgery checklist in 2016.

Methods: A retrospective, descriptive study was done in training general hospitals affiliated by Qom University of Medical Sciences from April to June 2016. All surgery checklists in this period were collected, and its use regarding to each operation was mentioned. Data were entered into SPSS version 20 and analyzed through descriptive statistical tests and One-way ANOVA.

Results: A total of 1771 surgeries in six university hospitals performed in three months study period and their related surgery checklists were investigated. The overall use and completion rate of checklists were 74%. Among which the sign-in, time-out, and sign-out items compliance were 58%, 16%, and 26% respectively.

Conclusion: The overall compliance rate of safe surgery checklist was satisfactory except for time-out and sign-out processes. Complimentary training and regular assessment of checklist utilization could be suggested to ensure the positive attitude among operating room’s staff about the value of such a safety tool in improving patient safety. 

 

Background: During 2009, Indonesia reported human cases of pandemic influenza A(H1N1) virus. Although the fatality rate was not as high as for H5N1 virus infection, genetic information has not yet been published. We generated whole-genome sequences from 28 influenza A(H1N1)pdm09 isolates during the first wave of the 2009 pandemic in Indonesia to determine the genetic characteristics related to clades, receptor-binding sites, antiviral resistance, virulence, pathogenicity, and polymerase activity.

Method: We detected, amplified, and sequenced the influenza A(H1N1)pdm09 viruses using real-time PCR, egg culture, reverse transcriptase PCR (RT-PCR), and Sanger sequencing. In addition, we analyzed the genetic characteristics using BioEdit and MEGA6 software.

Results: The phylogenetic analysis of the hemagglutinin (HA) gene showed similar clusters to one of the first 2009 pandemic viruses, A/California/07/2009. Resistance to amantadine in the matrix (M) gene was suggested by a fixed mutation, S31N. No mutations were found in the polymerase acid (PA) gene (T515A) or polymerase basic 2 (PB2) (E627, D701). An analysis of the neuraminidase (NA) gene did not indicate the presence of a deletion mutation, and the NS genes of the viruses did not contain the ESEV motif of the PDZ-binding domain.

Conclusion: This study produced comprehensive information through the genetic analysis of influenza A(H1N1) pdm09 viruses isolated during the 2009 pandemic outbreak. The findings of this study have increased the level of awareness of the importance of surveillance for monitoring the evolution of influenza viruses in Indonesia. 

Background: Phylantus niruri linn (PNL) extract  has potential cytotoxic effect  on colorectal cancer both on in vitro and in vivo study, but have never been reported in human subject. The purpose of this study is to elaborate whether PNL  extract  also has cytotoxic effect on human colorectal cancer. 

Method: A one group  pre-test and post test design was conducted on 15 patients with non obstructive operable rectosigmoid cancer without neo adjuvant chemotherapy or chemo radiation. Before PNL extract   (100 mg Stimuno) treatment, all patient underwent rectoscopy biopsy. Stimono treatment was given at least for 14 days and then patients underwent rectal resection. Speciment from biopsy and rectosigmoid resection were manage by Department of Anatomical Pathology Faculty of Medicine Gajah Mada University Yogyakarta for evaluating the diagnosis, infiltrating lymphocyte, apoptosis index, perforin, granzyme-B and caspase-3 expression.  A pair t test was done to evaluate the significant increasing measured variables and linear regression was done to evaluate the role of individual variable. 

Result: Infiltrating lymphocyte, expression of perforin, granzyme-B and caspase-3 and apoptosis index  were significantly (p=0.000) improve after PNL extract treatment. After linear regression, variable which  significantly correlate with apoptosis was only infiltrating lymphocyte.

Conclusion:  PNL extract increase apoptosis index of colorectal cancer  through increasing of infiltrating lymphocyte.

Background: Cooperative learning considered as one of the greatest innovations in the educational system. Jigsaw learning technique, one form of cooperative learning method, has been successfully used to improve academic achievement among students. The present study was conducted to compare the effectiveness of jigsaw technique with lecture-based teaching method for medical students’ physics course. Methods: A pretest was performed on the students to ensure their literacy. Relevant topics, i.e. bioelectricity (first subject) and application of electricity for diagnosis and treatment (second subject) were then presented to the two groups using mentioned methods. A questionnaire with a confirmed validity and reliability and a posttest were used to measure their learning and assess whether it was satisfactory or not. Results: The mean posttest scores differed significantly between the two groups (p < 0.001 for subject 1 and subject 2). More than 80% of the participants agreed or agreed with all the items that assessed their satisfaction with what they had learned in Jigsaw class. However, some of them were concerned about the sufficiency of their learning and their final score. Conclusions: Jigsaw learning technique is recommended as a proper method for teaching physics if the students’ concern about their final score can be resolved and the accuracy of the information conveyed to them is ensured.

Background: One of the indices for measuring the performance of any organization including hospitals is the satisfaction of their customers. The purpose of satisfying is client judging of the rate of his expectations from services that they had taken. Patients are expected to care taken by individuals that having a mutual understanding. In the major studies role of traits behavioral and intelligence variety of the medical staff is highly significant on the patient satisfaction, including the intelligence is spiritual intelligence that could help the relationship between staffs and patients. Having high intellectual intelligence help to medical staffs to understand their services meaningful and cope better with the pressures of work. Despite numerous studies which did not consider the effect of a variety of the medical staffs’ intelligence on the patients' satisfaction. In line with this lack, the purpose of this paper is to investigate the relationship between the spiritual intelligence of nurses with patients' satisfaction with nursing care. Methods: This was a descriptive-analytical study that evaluates nursing staff and patients admitted to hospitals in Kermanshah. To collect data, spiritual intelligence and patients' satisfaction questionnaire were used. The data were analyzed by software SPSS22, using descriptive statistics (percent, diagram, mean) and Pearson correlation coefficient. Results: the results showed a significant relationship between nurses spiritual intelligence and patient satisfaction(r=.69, p<0.05). 30% of the nurses had average spiritual intelligence, and patients' satisfaction was desirable. The most satisfying was from the area of utility services (66.9%), the satisfaction of nurses (98%), and satisfaction of doctors (93%). The lowest satisfaction is in the field of patient education and receives information (31.53%). Conclusion: There was a meaningful relationship between nurses’ spiritual intelligence and patient satisfaction. Therefore, considering spiritual dimensions in staffs can increase the quality of care and patient satisfaction.

Background: Pediatrics thyroid cancers tend to be at more advanced stages at the time of diagnosis and have higher frequency of recurrences than adulthood thyroid cancers. The aim of study was to evaluate clinical characteristics and outcome between children and young adults patients with Differentiated Thyroid Cancer (DTC) treated in our hospital. Material and Methods: The medical records of 144 patient with DTC who underwent thyroid surgery followed by radioiodine and thyroid hormone suppression were retrospectively reviewed. Subjects consisted of 43 patients who were younger than 21 years old, and 101 young adult patients (older than 21 years old but younger or equal to 40 years). The clinical characteristics and outcomes were analyzed and compared, then Recurrence Free Survival (RFS) was evaluated using Kaplan-Meier Methods. Results: Female has higher tendency to have thyroid cancer than male (p = 0.006). Based on histopathology report, classic papillary thyroid cancer is the most common cancer type in children than young adult. However, there was no significant difference between two groups regarding thyroid cancer size and multifocality (p=0.815 and p=0.370). The risk of recurrent ratio of children to young adults is 3.88 (95% CI  1.38; 10.91). Similar result trend is shown for sex type, histopathology type, number of nodules, surgical technique and metastasis parameters. (adjusted HR =  7.91, 95% CI 2.11; 29.67). Conclusions: Differentiated Thyroid Cancers in children show more aggressive behavior compared to young adult patients.

Background: Sunscreens are cosmetic products which are used to protect the skin from ultraviolet (UV) rays exposure. Ultraviolet rays, especially ultraviolet B (UVB) rays can cause skin cancer. C-phenylcalix-[4]-resorcinaryl octacinnamate (compound 1) and C-methylcalix-[4]-resorcinaryl octabenzoate (compound 2) are newly synthesized compounds which have high absorbance of UVB rays. Despite their potential activity, these compounds have low solubility in water. Therefore, in order to increase the solubility, they were formulated into  a nanoemulsion.

Objective: The aim of the present study was to prepare and characterize a self-nano emulsifying system of two compounds as UV absorber.

Methods: Optimum formula of nanoemulsion was analyzed using D-optimal mixture design with Design Expert® ver. 7.1.5 by varying concentrations of candlenut oil, tween 80, and polyethylen glycol 400 (v/v). Sun Protection Factor (SPF), transmittance and time of emulsification were evaluated as optimization parameters. The optimal formula was further evaluated for its distribution, droplet size, and zeta potential.

Results: A combination of two compounds was used in formulations and has SPF value of 52.189. The composition of optimal formula was obtained at 2.5 mL of candlenut oil, 5.066 mL of tween 80, and 2.434 mL of polyethylene glycol 400. The results showed that the optimal formula has SPF value of 81.577, % of transmittance 90.84, emulsification time of 17.42 seconds, desirability of 0.726, average droplet size of 129.9 nm with polydispersity index 0.393 and zeta potential of -15.2 mV.

Introduction: Due to ever-increasing changes and complexities of social relationships in the present era, it is essential to prepare individuals especially young generation to deal with difficult situations. Training life skills is a must because it can promote psycho-social abilities. Objective: This research aimed to study the effectiveness of training life skills on the mental health of female students of 2^nd-grade high school residing in Bam, Iran. Method: This is a quasi-experimental study with two groups with pre-test and post-test design. General Health Questionnaire (GHQ-28) was employed to collect the data. A sample of 40 students was selected using convenience sampling. They were selected out of students who visited Payam-e Hedayat Educational-Cultural Complex to participate in GPA Promotion Program. They were randomly assigned to control and experiment groups. 16 sessions of training were held. After one month, post-test was performed. The data were analyzed using MANOVA. Result: Findings showed that training life skills caused a significant difference in mental health compared to pre-test. Conclusion: It is therefore concluded that training life skills can increase the mental health of female students on the 2nd-grade high school of Bam, Iran.

Introduction: People with diabetes have delayed sleep compared to ordinary people and do not have good sleep quality because of impaired glucose level. Saffron effect on insomnia in several studies on animals have checked, and beneficial results for it have observed.

Methods: This study was a quasi-experimental study aiming to determine the effect of oral saffron capsules on sleep quality in diabetic patients in the city of Zabol in 2016. This study conducted on 50 diabetic patients in Zabol city which were qualified for inclusion criteria for the study. The sleep quality of patients assessed with Pittsburgh Sleep Quality Index (PSQI). Then the intervention was done as a daily intake of one 300 mg capsule of saffron in the intervention group and a placebo capsule in the control group, for a week, every day between hours 12 to 14 am and after taking lunch. After a week, sleep quality measured again.

Results: After the intervention, the comparison of the mean scores of two groups showed a significant difference (P = 0.001). Also, comparison of a total mean score of sleep quality in patients before and after intervention showed statistically significant difference in two groups (p = 0.001).

 Conclusion: Results of this study showed that daily administration of saffron oral capsules improves sleep quality in diabetic patients. Saffron can use for improving sleep quality in diabetic patients along with other existing therapies.

Background: Checking the health status is one of the main components of nursing care. Failing to use active and learner-based educational methods might cause failures in analysis skills and clinical examinations.

Objectives: This study was conducted in order to study the effect of blended training (programed and lecture-based training) on learning health status assessment course among nursing students.

Design/Settings/Participants/Methods: Over a semi-experimental research with two post-test groups, 60 freshmen nursing students in two educational centers were selected through convenient sampling method and randomly placed in intervention (30 people) and control (30 people) groups. As for the intervention group, the instructor held four two-hour of health status course every week in blended method (programed and lecture-based education). The same content with the same number of sessions was delivered by the same instructor just through lecturing method. The tool used to collect data was a researcher-made test composed of two sections of demographic information and 40 multiple-choice questions. SPSS 15 and statistical tests such as chi-square and independent t were used to analyze the data.

Findings: the average post-test scores of health status were obtained for both blended (11.50 ± 1.45) and lecture-based (10.55 ± 2.01) educational methods. Independent t test for groups indicated a statistically significant difference between the post-test results of the two groups (P = 0.04).

Conclusion: blending lecture-based educational method and individual education methods such as programed education can enhance the learning quality of students.

Objective: Antipsychotic drugs are the first-line therapy of psychotic disorders. The aim of this study is to compare the response rapidity of the first and second generation antipsychotics in the treatment of acute psychosis. Methods: In a randomized, double-blind, controlled clinical trial, thirty patients with acute psychosis were randomly allocated into three groups and treated with each of the three antipsychotics: Aripiprazole, risperidone, and perphenazine. The onset of response to each drug was assessed by the Positive and Negative Symptoms Scale. Results: Initial response was seen in 66.6 % of subjects during two weeks of intervention. The mean time of response in the risperidone group was 9.6 days, in the aripiprazole group 11.1 days, and in the perphenazine group 11.3 days. Individuals who received risperidone reached the event sooner than the other two groups. Conclusion: The result of this trial suggested that the response rate of the proposed three drugs was equal, but the onset of action of aripiprazole was slower than risperidone and perphenazine.

Introduction: Noise exposure could result in damage to the organ of Corti and decrease the blood flow of the cochlea, thus resulting in cochlear hypoxia, whereas cigarettes are reported as an ototoxic to the cochlea and as a trigger of cochlear ischemia. Based on that theory, smoking habits and exposure to noise, either alone or together, could cause hearing loss

Objective: To determine the correlation between smoking and Noise Induced Hearing Loss (NIHL)

Method: Analytic with a cross-sectional study

Result:  Of the 122 workers, the proportion of NIHLwas 89.3%, with mild deafness (68.8%) as the most common proportion. We found that there was a significant correlation between types of smokers and severity of hearing loss (p = 0.000). Workers who smoke are likely to experience NIHL1.224 times more likely than non-smokers (PR = 1.224, p = 0.002, CI 95% = 1,077 - 1,392).

Conclusion: There is significant correlation between smoking and noise induced hearing loss

The antibiotic administration could potentially to affects metabolism and physiology by altering the gut microbiota composition and diversity. As early life is a critical period for metabolic development, microbiota disruption during this window period could have a significant implication to the health status.  In humans, early-life microbiota disruption has been proven to be associated with increased risk of overweight later in childhood. As the use of cefixime is rising in pediatric clinical infections, it is important to determine the changes in gut microbiota composition after early-life exposure of this antibiotic. In this study, six-week old male Wistar rats were used as an animal model, divided equally into a control group and cefixime group. Both groups were transplanted orally with feces from 7-months old infant boy prior to antibiotic administration. Cefixime group was given cefixime orally twice a day for five days in 3 consecutive periods with one-week interval. Microbiome analysis from caecal content was conducted to determine the changes in gut microbiota composition. This study found an increase in relative abundance of Bacteroides and decrease in relative abundance of Firmicutes. An increase in Bacteroidetes/Firmicutes ratio by 32% was also observed. It was concluded that early-life-repeated-administration of cefixime in rat has a significant increase in Bacteroidetes/Firmicutes ratio.

Background: The rapid detection of influenza viruses from clinical samples is important for establishing public health  and clinical decisions, including infection prevention and control measures. The SD Bioline rapid influenza test (Standard Diagnostics, Inc., Suwon, Korea) is a point-of-care (POC) diagnostic test which based on influenza-specific monoclonal antibodies. The purpose of this study is to assess the performance of this assay against the reference diagnostic standards of RT-PCR for Influenza diagnosis in Surveillance activity.

Methods: 4,262 nasal and throat swab specimens were collected from influenza-like illness (ILI) patients from sentinel hospital and health-care sites across 10 provinces in Indonesia. Specimens were tested with the SD Bioline rapid influenza test in sentinels and rRT-PCR test was conducted in referral laboratory in Jakarta. Data analysis was performed by comparing the results of rapid test conducted in the POC settting and the results of  rRT-PCR test.

Results: Testing of throat and nasal swabs from children and adults indicated the specificity of The SD Bioline rapid influenza test to be 97% for influenza A and B, respectively, in 4262 specimens. However, the overall sensitivity of the SD Bioline rapid influenza test  for these samples was  low at 25%.

Conclusions: Overall, the results indicated that the SD Bioline rapid influenza test has a high specificity but low sensitivity for detection influenza from throat and nasal swabs therefore it will be a challenge of laboratory testing on site.

Keywords: Influenza, rapid diagnostic test, surveillance

Introduction: The correct alignment of femoral components is necessary to achieve a successful total knee arthroplasty (TKA) and preventing complications such as pain, stiffness, loosening, instability; which itself, depends on making perfect cuts. The posterior distal femoral cut, is one of the most important factors. Yet, the best method of its measurement is controversial.

Methods: In this study, 20 cadavers of femoral bones were used; on which, the distal femoral rotation (DFR) was measured manually by 8 orthopedic surgeons and also was calculated on the basis of the trans-epicondylar axis (TEA) by 2 orthopedic surgeons and 2 radiologists on CT scan image. Accuracy and reliability were assessed in both groups, and the risk of severe malrotation was determined according to an outlier defined as 3 and 5 degrees.

Results: The mean DFR measured manually, was 1.8±2.1º and the one attained by CT scan images was reported 3.3±1.1º, projecting a remarkable difference between two groups. The Kappa reliability index was calculated about 0.81 in CT scan results and 0.64 in the other group. (k>0.7 was considered as valuable). With an outlier defined as 3º, from the normal distal femoral rotation based on posterior condylar axis (PCA), 3º external rotation; 12% of data were outlying in the manually of measured data, and there was no outlier data were reported in the other group. (With a statistically significant difference between two groups)

Conclusion: According to the unreliability and noticeable risk of error in measuring DFR manually based on TEA, this study suggests using CT scan in the patient’s pre-op assessment to obtain the most accurate data.

Beluntas Leaf (Pluchea indica L) has been shown to have antibacterial activity against Streptococcus mutans. The leaf of avocado (Persea americana Mill) that have same active substance with beluntas leaf expected to have antibacterial activity against Streptococcus mutans so that the purpose of this research is to compare the ability of ethanol extract from avocado leaf and beluntas leaf in inhibiting the growth of Streptococcus mutans. This research is experimental type, using completely randomized with posttest only control group design. Samples were pure isolates of Streptococcus mutans ATCC 35668. The sample of 90 divided into four groups: beluntas leaf ethanol extract 25%, beluntas leaf ethanol extract 50%, avocado leaf ethanol extract 25%, avocado leaf ethanol extract 50% and two control groups. The data were analyzed using One-Way ANOVA test followed by Least Significant Difference (LSD) with a 95% confidence level. The results showed a significant inhibition differences between the control group and the treatment group with a value of p = 0.000 (p <0.05). The ability of 25% ethanol extract of beluntas leaf (Pluchea indica L) is equivalent to 50% ethanol extract of beluntas leaf (Pluchea indica L) and 50% ethanol extract of leaf of avocado (Persea americana Mill) in inhibiting the growth of Streptococcus mutans. It is recommended that further research conducted to test the mechanism of action of the active substances contained in beluntas and avocado leaf as an antibacterial and test MIC (Minimum Inhibitory Concentration) with an advanced test in determining the MBC (Minimal Bactericidal Concentration). 

Introduction: Hospitalization for surgery is associated with stress and anxiety for most patients. Candidates for Coronary Artery Bypass Grafting (CABG) experience a lot of stress and tension. This study aimed to identify and explore the determinants of stress in CABG patients.

Methods: This qualitative study builds on content analysis. The sample consisted of 21 CABG patients. Data was collected via unstructured interviews, and the sample was selected based on purpose and with maximum variation. The process of data analysis proposed by Graneheim and Lundman was followed. Credibility and dependability of the study were assured according to Guba and Lincoln’s evaluative criteria.

Results: The results were categorized into three main themes and five categories in terms of nature. The three-emerging themes include "presentation", "situational determinants", and "uncertainty".

Conclusion: Mental stress affects the length of stay in the hospital, postoperative pain, and quality of life. It is necessary to identify the most important stressors perceived by CABG patients, to control stress, and hence to comfort patients mentally by healthcare providers.

     

Background: Ethics is a curriculum subject, but it is also a manner of being a professional as well. It is necessary to increase the nurses’ ability in making ethical decisions and pay attention to academic training. Materials and Methods: This study is a descriptive research that was conducted on 127 nurses and nursing students to study the level of awareness of nurses and students about professional nursing ethics and to find the causes influencing such awareness. A nursing profession ethics questionnaire was used as the research tool. The data was then analyzed using SPSS16 statistical software through descriptive statistics, Chi-square, independent t-test, and Pearson methods. Results: There was no significant relationship between professional ethics score and personal details such as age, sex, academic semester, GPA, and being a nurse or student (p>0.05). However, in the students’ group, there was a significant relationship between an interest in the field of study and the ethics score (p<0.05). There was no significant relationship between the ethic score of students’ group and nurses’ group (p>0.05). The mean score of ethics of both groups of students and nurses was at a medium level. Discussion and Conclusion: According to the results of the study, moral judgment of both students and nurses’ groups in clinical settings was evaluated as medium level. This is considered insufficient for”morally demanding” jobs like nursing. Therefore, there is a need to increase the efforts in the field of ethics education and continuous assessment of the ethical performance of the nurses.

Introduction: Depression is a chronic but curable disease that early diagnosis and treatment can lead to a higher life quality. A supplementary treatment such as exercise can reduce depressive symptoms. Tai Chi Exercise is easy to learn and easy to do for older adults in nursing homes. This study investigated the effect of Tai Chi exercise on depressive symptoms in elderly residents at Sadeghieh Nursing Home.

Method & material: This is a pre-test, post-test experimental study. Subjects included 62 elderly adults above 60 years of age who were randomly divided into four experimental subgroups and a control group. Participants were older adults who had not been participated any exercise activity during the previous month. The ten step Tai Chi exercise performed three times per week for twelve weeks in experimental groups and a control group doing only their activity of daily living(ADL). The Beck depression Inventory Second Edition(BDI-II) was used to assess depression.

Results: This study shows a statistically significant difference between depression mean scores in the experimental group compared to the control group(p<0.01). After adjustment of The mean older adults age, the differnece remained significant.

Conclusion: This study showed that Tai Chi Exercise helps reduce depression in the older adult in residential homes. Social interactions thorough Tai Chi sessions and a sense of group belongingness may help reduce depression in older adults.

Introduction

It is still of top priority to find a method to measure creatinine clearance in patients with acute kidney injury (AKI) in order to regulate drug dosage and avoid treatment failure. Therefore, the present study was an attempt to compare creatinine clearance measured with 6-hour urine and creatinine clearance measured by formulas and bio-impedance method in patients with AKI hospitalized in ICU.

Materials and methods

In the present prospective cross-sectional study, 28 adult patients with an increase in serum creatinine of at least 0.3 according to AKIN criteria and admitted in ICU of Imam Hussein Hospital were selected as the study sample. For all of the patients who entered the study, creatinine clearance was measured by collecting 6-hour urine through electrical bio-impedance method or formulas of Cockcroft and Gault, MDRD, and CKD-EPI. After the required data were collected, they were recorded in pre-prepared checklists, and finally fed into a software to be statistically analyzed. At last, the obtained creatinine clearances were compared with those measured by collecting 6-hour urine so as to specify the best formula or method to determine creatinine clearance in patients with AKI.

Results

The results showed that the bias values of bio-impedance compared to 6-hour urinary clearance, MDRD, Cockcroft, and CKD-EPI were respectively 6.34, 3.31, 5.01, and 15.14. Also, error values of bio-impedance compared to 6-hour urinary clearance, MDRD, Cockcroft, and CKD-EPI were respectively 140%, 28%, 60%, and 47%. The internal consistency of the bio-impedance values by the above methods was respectively 0.782, 0.983, 0.939, and 0.893. According to the results of the present study, bio-impedance did not have an appropriate capacity to measure creatinine clearance or estimate GFR in patients with AKI.

Conclusion