Journal of Clinical Care and Skills
Year:2023 | Volume:4 | Issue:2|Papers Count:8

Aims: A catastrophic side effect of retroperitoneal perforation after ERCP is the development of pneumothorax. Due to this fatal unexpected complication, clinicians and gastrointestinal specialists should observe the patients regarding ERCP by proper physical examination. Patient & Methods: The patient was a 52-year-old woman with CBD stone who underwent surgery for severe abdominal pain after ERCP, but because of her general condition deterioration after surgery and the evidence of pneumothorax in chest x-ray, she underwent chest tube insertion and tissue debridement of necrotic tissue. Findings: Pancreatitis is a common complication post-ERCP; However, it tends to be right-sided or bilateral, while in our case, the pneumothorax involves the left side. This scarcity seems to be as a result of the adhesions between the retroperitoneum and anterior aortic sheath as an anatomic barrier. Conclusion: Post-ERCP pneumothorax can occur in different pathophysiological ways, but the most important step in this regard is to identify this ominous complication and take appropriate treatment as soon as possible.

Aims: Improving oral hygiene is a part of the nursing care in oncology centers. Its maintenance can also play an important role in improving Oral Health-Related Quality of Life (OHRQOL). This study investigated the effect of natural grape vinegar and rosewater solution on oral health-related quality of life in chemotherapy patients. Materials & Methods: A randomized controlled trial was conducted on 60 chemotherapy patients. Patients were randomly assigned to one of two groups of intervention and control. The participants rinsed their mouths with grape vinegar and rosewater solution for one minute thrice daily for 14 days. An oral Health Impact Profile was used for data collection. Data were analyzed by SPSS 21, using descriptive statistics methods and inferential analysis tests, including an independent sample T-test. Findings: The global mean score of oral health-related quality of life in the chlorhexidine group was 31.8±4.8 and19.5±4.6 for one day before and 21 days after the intervention, respectively. These values for grape vinegar and rosewater group patients were 30.8±6.3 and 14.1±4.1, respectively. The independent sample T-test showed a significant difference between the two groups at 21 days after the intervention. Conclusion: Grape vinegar and rosewater combined solution improves OHRQOL in chemotherapy patients.

Aims: Different corticosteroids with different characteristics, such as hydrocortisone and dexamethasone, have been used to treat exacerbated chronic obstructive pulmonary disease, but the drug of choice is unclear. The main goal of the present study was to compare the efficacy of hydrocortisone and dexamethasone on clinical symptoms, peak expiratory flow, oxidative stress factors, and inflammatory mediators in patients with exacerbation of chronic obstructive pulmonary disease. Materials & Methods: In this single-blind randomized clinical trial study in 2021, 70 eligible patients with chronic obstructive pulmonary disease exacerbations were selected and randomly divided into two A (8mg of intravenous dexamethasone daily) and B (200mg of intravenous daily hydrocortisone) groups. Clinical symptoms and peak expiratory flow were measured before intervention (day 1), after intervention (day 2), and on discharge day. However, oxidative stress factors and inflammatory mediators were evaluated on day one and discharge day. Moreover, the probable complications of both drugs were measured and scaled 1-4 by the researcher. Findings: Between groups, comparisons showed significant differences in the patients’ clinical indicators for shortness of breath (p=0.02), sputum volume (p=0.01), and oxygen saturation of arterial blood (p=0.02). However, these differences were related to the first day, and no statistically significant differences were observed on the second or discharged days. The intragroup comparison revealed that the prescription of both dexamethasone and hydrocortisone led to significant improvement in the patient’s clinical symptoms. Conclusion: Dexamethasone and Hydrocortisone are the same in improving important clinical symptoms and have similar efficacy on inflammation and oxidative stress in patients with COPD exacerbation.

Aims: Pilates is a sport that may play a role in reducing pain and healing burns faster like other sports, but these effects have not been investigated in a study. Therefore, this study aimed to investigate the effect of Pilates exercise on pain control and wound healing among patients with second-degree burns. Materials & Methods: This randomized clinical trial in which 64 patients were randomly divided into intervention, and control groups was conducted in 2019 in Amir al-Momenin Burn Injury Hospital in Shiraz, Iran. Intervention group patients received 12 sessions of 45 to 60 minutes of Pilates exercise individually and control group patients received routine care. In both groups, pain was assessed once before and 11 times after the intervention using the Visual Analogue Scale. Like pain, wound healing was assessed in both groups once before and 7th day and 14th days after the intervention using the Bets-Jensen Wound Healing Questionnaire. The data were analyzed using SPSS 21 software. Findings: In all times of the measurement, the mean of pain score and wound healing after the intervention were significantly improved in intervention group than control group (p< 0.05). Conclusion: Pilates exercise improves pain and burn wound healing in burned patients and it can be considered as a complementary intervention in the management of pain and wounds among patients with second-degree burns by health care providers.

Aims: Surgical incisions have been performed by a scalpel for many years, and today, the use of an alternative method, catheter incision, is increasing daily. This study aimed to evaluate the complications of using electrocautery and scalpel in surgical abdominal wall incisions in hysterectomy surgery. Materials & Methods: The present single-blind study was performed on 92 eligible women undergoing hysterectomy surgery with a transverse incision in Imam Sajjad Hospital, Yasuj, Iran. Patients were randomly divided into hysterectomy with a scalpel (46 samples) and electrocautery (46 samples). Then, post-surgery infection after the surgery, the extent of wound separation after a month, pain intensity in the first, second, and eighth days after the surgery, blood loss (weighting consumed blood gauzes before and after surgery), in both groups of scalpel and electrocautery were measured and compared. The collected data were analyzed using descriptive statistics in SPSS 19 software. Findings: The two groups were similar in age, cause of hysterectomy, and type of delivery. There were no significant differences between the two groups in postoperative infection rate, incision time, and wound separation rate. However, a significant difference was indicated in the distribution of pain intensity in the electrocautery group on the first (p<0.001), second (p<0.001), and eighth day after surgery (p=0.03), and blood loss (p=0.017), which were reported significantly lower than in the scalpel group. Conclusion: The electrocautery method causes less pain intensity and blood loss than the scalpel method.

Aims: Fear of childbirth (FOB) in pregnant women is critical because it may affect prenatal outcomes. This study aimed to determine the effect of cognitive-behavioral education on fear of childbirth during pregnancy. Materials & Methods: A clinical trial study with two intervention groups and one control group was conducted among nulliparous women visiting Gorgan health centers in the first six months of 2018. Among 211 nulliparous pregnant women, 104 with a FOB score of 55 or higher were divided into control and intervention groups. The women in the intervention group were randomly assigned to two groups. The first intervention group received conventional prenatal education, the second group received cognitive-behavioral techniques, and the control group received routine prenatal care. The data collection tool was the Wijma Delivery/Expectancy Fear of Childbirth Questionnaire (version A). The data were analyzed using SPSS version 18 and Chi-square, Fisher’s exact test, ANOVA, and Welch. Paired t-test, Wilcoxon tests, ANOVA, and Kruskal-Wallis tests. Findings: Comparing the rate of change in the scores of FOB indicated significant differences in all fields between the control and cognitive-behavioral techniques groups (p<0.05), but the conventional prenatal education group showed no significant difference (p>0.05). However, the control group exhibited a significant increase in all fields of FOB, while the cognitive-behavioral techniques group showed a significant reduction. Conclusion: FOB is reduced more in pregnant women with prenatal education based on cognitive-behavioral techniques than conventional education.

Aims: In preterm delivery, uterine contractions begin prematurely and lead to the opening of the cervix. Nifedipine and Indomethacin drugs can help reduce contractions and delay childbirth.  However, there are contradictions regarding their effect on preterm birth and inflammatory factors. This study aimed to compare the effect of nifedipine and indomethacin on uterine contractions, CRP, and white blood cells in pregnant women with idiopathic preterm labor. Material and Methods: This single-blind clinical trial was conducted on 68 eligible pregnant women hospitalized with premature labor pains in Imam Sajjad Yasuj Hospital in 2022 and randomly assigned to two groups. With tocography, the fixation contractions must have at least four contractions higher than 15mmHg. Before and 48h after interventions, the number and time of contractions, cervical dilatation, WBC, DIFF, and CRP tests were measured. Data were analyzed using SPSS 25 software. Findings: Both interventions improved the number and time of contractions, CRP, and neutrophil. However, there were no significant differences in these variables between Nifedipine and Indomethacin groups. The study showed a statistically significant difference between groups in the number of eosinophils and monocytes after the intervention (p<0.05). Conclusion: Nifedipine and Indomethacin improve the number and duration of contractions, CRP, monocytes, and neutrophils. Nifedipine causes more decrease in eosinophil levels than indomethacin.

Aims: Research has shown that most elderly suffer from knee osteoarthritis. Massage therapy is one of the non-pharmacological methods that, according to studies, can relieve the symptoms caused by knee osteoarthritis in the elderly. Therefore, the present study was conducted to reach a comprehensive view of massage therapy in relieving the symptoms of knee osteoarthritis in the elderly. Information & Methods: This systematic review was conducted in 2022 by searching Magiran, SID, IranMedex, Science Direct, Ovid, Web of Sciences, Scopus, and Pubmed databases with knee osteoarthritis, massage therapy, pain, range of motion, and the elderly keywords alone and in combination during 2008-2022. Findings: Out of 12 selected articles, one Persian article, and 11 English articles were clinical trials. In the studies, different types of massage were used for different periods. Most of the studies showed the effect of massage in reducing pain, joint stiffness caused by knee osteoarthritis, and the physical function of the knee at least four weeks after stopping the massage. However, after the specified period, this effect was reduced. In one study, the results showed that massage therapy had a positive effect on the knee's range of motion, and two studies indicated that massage did not affect the knee's range of motion. Conclusion: Various types of massage has a positive effect on relieving knee pain and knee joint stiffness and improving the functional problems of the elderly with knee osteoarthritis for a long time. Therefore, there is a need for long-term massage or its repetition