Journal of Clinical Care and Skills
Year:2023 | Volume:4 | Issue:3|Papers Count:8

Aims: The use of electronic health record systems has been developed in the health system, but it is still not clear whether empathy is created in patient visits with this system. The present study aimed to compare patients’ perceptions of physicians’ empathy after the patient viewed standardized and scripted video vignettes of two physicians, which one used the electronic health record system during his visit, and the other one visited the patient without electronic health record system. Materials & Methods: This study is a cross-sectional, double-blind, quasi-experimental study with only a post-test, which was conducted in Isfahan Omid Hospital, Isfahan, Iran. 120 eligible patients were selected using convenience sampling method and randomly divided into two groups (each 60 patients) in a cross-over study plan. In group 1, the first arm viewed the electronic health record video, and the second arm viewed video of visit without electronic health record, and in group 2 vice versa. The data were gathered by Jefferson Scale of Patient Perceptions of Physician Empathy, after each intervention. Finding: The video of the visit without the electronic health record system compared to the visit with the electronic health record system had a significantly better empathy score in each arm of the participants (p<0.05). Conclusion: Cancer patients perceive more empathy in physicians who do not use the electronic health record system during visits and consider this strategy more empathetic.

Aims: Bacteria are one of the main factors involved in the process of tooth decay and are the main cause of pulp and periapical diseases. Their presence in the crown pulp and dental canal causes symptoms in the teeth. This study aimed to investigate the molecular analysis of anaerobic bacteria in primary and necrotic teeth of children and to determine the relationship between these bacteria and clinical signs and symptoms. Materials & Methods: In this analytical cross-sectional study, 90 children aged 4-12 years were divided into five equal groups (n=18), including reversible pulpitis without irritant pain, reversible pulpitis with irritant pain, irreversible pulpitis, necrosis with abscess, and necrosis without abscess. Clinical symptoms of the patient, such as history of pain, luxation, sensitivity to percussion, status of the dental pulp, and presence of swelling were recorded, and samples were taken from coronal pulp tissue and root canals during pulp treatment using sterile paper points. To identify anaerobic bacteria, clinical samples were cultured under anaerobic conditions. The 16s rRNA sequencing was used for molecular identification of anaerobic bacteria at species level. Findings: In 90 patients, 9 different Lactobacillus spp. were identified which among them L. fermentum (37.8%), L. rhamnosus (15.6%), L. salivarius (10%), and L. gasseri (5.6%) were the most prevalent. L. fermentum was the most common species found in all clinical samples that was related to pain (p=0.034). Conclusion: L. fermentum is the most common species found in all clinical samples that is related to pain.

Aims: Breast fissure is one of the common reasons to refuse breastfeeding after giving birth. Reducing the healing time of breast fissures prevents breast problems. Herbal products are one of the care and treatment options for breast fissures. This study aimed to systematically review herbal products in the care and prevention of breast fissures. Information & Methods: This systematic review was conducted by searching the keywords such as medicinal plant, complementary therapies, herbal therapy, herbal medicine, breast fissure, sore nipple, nipple fissure, and breast wound in databases including PubMed, Scopus, Web of Sciences, Cochrane Central, and ProQuest, and Persian meaning of these words in SID and Magiran databases without time limit until October 2022 was done. Findings: Finally, 21 articles, including 12 plants, were reviewed. Most of the investigated plants improved nipple fissures and reduced the severity of nipple pain. The results of several studies on the effect of aloe vera on the healing of cracked nipples were consistent. Conclusion: Most of the herbal products used in the care of breast fissures are effective in healing fissures and relieving nipple pain. Various medicinal forms prepared from aloe vera were reported to be effective in treating cracked nipples in all studies conducted in this field. Due to the existence of contradictions in the results of some plants and the insufficient number of articles in other plants, it is necessary to conduct more studies to reach a reliable result.

Aims: Children and adolescents are more exposed to trauma due to their physiological conditions and growth processes. After the discharge, the complications caused by trauma affect the quality of life of children and adolescents or their families. Therefore, the present study aimed to determine the effect of using the IDEAL discharge planning on the quality of life of children and adolescents with trauma. Materials & Methods: In this quasi-experimental study, 150 traumatized children and adolescents aged 8 to 16 years admitted to the trauma department of Golestan Hospital, Ahvaz, Iran, in 2023 were selected by available sampling method and divided into two groups of 75 people (intervention and control). For patients in the intervention group, training on the IDEAL discharge model was implemented, and control group received routine training. Varni et al.'s Pediatric Quality of Life Inventory Generic Core Scale, version 4, was used to collect data. Data were analyzed using SPSS 25 software through independent t-test, paired t-test, and Chi-square test. Findings: After the intervention, the mean quality of life score in the intervention group showed a significant improvement compared to the control group (p<0.01). In the intra-group comparison, in each of the intervention and control groups, the average quality of life score after the intervention showed a significant increase compared to before the intervention (p=0.001), but this increase was higher in the intervention group than in the control group. Conclusion: The IDEAL discharge planning method increases and improves the quality of life in children and adolescents with trauma.

Aims: Secondary bleeding after tonsillectomy is unavoidable. If it leads to a life-threatening event, it will likely be associated with a malpractice claim against the surgeon. Very few reports have addressed this event from a medicolegal point of view. Therefore, the present report aimed to investigate litigations following secondary post-tonsillectomy hemorrhage leading to death or life-threatening events in three patients. Patients & Methods: Here, we report three cases of life-threatening secondary post-tonsillectomy hemorrhage referred to the Legal Medicine Organization by the prosecuting attorney to give an expert opinion about any medical negligence. Findings: Two cases resulted in death and underwent medicolegal autopsy. The third one caused a cardiopulmonary arrest followed by neurological deficits after successful resuscitation. All three were children between 8 and 9 years old, and the time from surgery to post-tonsillectomy hemorrhage was between 30 hours to 13 days. No vascular anomaly or iatrogenic vascular injuries were found at autopsy. A review of the literature revealed that post-tonsillectomy hemorrhage is common and unpreventable Conclusion: In none of the cases medical malpractice was found as a contributing factor, and the complication was regarded as unpreventable.

Aims: Several methods have been proposed to improve growth in neonates, including touch and massage therapy. However, there are conflicting results about the effect of massage. Therefore, this study aimed to determine the effect of massage therapy on body mass and head circumference indices of healthy infants and by gender. Materials & Methods: In this randomized clinical trial study, 60 healthy infants were selected by convenience sampling method and randomly stratified with blocks of 4 in two groups of 30, including experimental and control groups (17 boys and 13 girls in each group). Experimental group neonates were given tactile-motor stimulation by their mothers at home for 15 minutes and twice a day, before feeding, for 4 consecutive weeks. Infants' growth indices were recorded at birth, at the end of the 14th and 28th day. Data were analyzed by SPSS 16 software using independent t-test, repeated measures ANOVA, and chi-square. Findings: In all the neonates, the body mass index increased from 12.37±0.81kg/m2 to 14.61±0.98kg/m2 in the intervention group and from 13.19±1.16kg/m2 to 15.22±1.03kg/m2 in the control group. The head circumference in the intervention group improved from 34.66±1.19cm at birth to 37.30±970cm at 28 day, and in the control group it increased from 34.50±1.57cm at birth to 36.81±1.41cm at 28 days. However, the differences in none of these indicators were significant (p>0.05). Conclusion: Massage with the method of tactile movements in general and based on gender did not improve the body mass index and head circumference of healthy babies.

Aims: Cancer patients have to face the disease, invasive treatments and side effects of the disease and treatments in a long period. In the long process of diagnosis, treatment and recovery, these people have different needs that often remain unrecognized and unmet. The present study aimed to evaluate the care needs of cancer patients in various aspects of life. Information & Methods: This study is a systematic review. To obtain related studies, research keywords were searched in Persian and English scientific databases. A total of 61 articles in Persian language and 265 articles in English language were obtained. After evaluating these articles based on the inclusion and exclusion criteria, 6 articles in Farsi and 28 articles in English were included in this review and their results were analyzed. Findings: After reviewing the full text of the articles, the reported needs of cancer patients were categorized into five general areas: need for support, informational needs, spiritual needs, sexual needs, and family needs. Conclusion: Cancer patients have specific and unfulfilled needs in different dimensions of their lives. These needs have a significant impact on disease outcomes, compliance with treatment, the success rate of the treatments performed, and the quality of life of patients.

Aims: Ovarian cancer has the worst prognosis among female genital tract malignancies, but if detected in the early stages, it is one of the most treatable malignancies. This study aimed to investigate the diagnostic value of tumor markers compared to ultrasound in the diagnosis of ovarian tumors. Instruments & Methods: This cross-sectional-analytical study was conducted on 210 women referred to women's specialized clinic in Yasuj City, Iran, from 2017 to 2021 who were candidates for ovarian surgery. The method of data collection was patients interviewing and using the information available in the file. The data was analyzed using SPSS 22 software. Findings: The most common histological pattern was ovarian epithelial masses (64.28%), of which 72.18% were larger than 10cm in ultrasound. There was a significant correlaion between the serum level of two tumor markers CA125 and HE4 in ovarian cancer (p=0.0001), but no correlaion was observed between the surgical stage and differentiation grade of ovarian cancer. The sensitivity of ultrasound was 78.9% and the sensitivity and specificity of HE4 tumor marker were 85.4% and 81.7%, respectively. The lowest specificity was related to the tumor marker CA125 (59.3%). Conclusion: Ultrasound has relatively high sensitivity for detecting ovarian tumors, but CA125, with relatively high sensitivity and moderate specificity and HE4, with high specificity and high sensitivity, as two tumor markers, are not suitable for screening these tumors alone and should be performed together with ultrasound.