Background & Aim: Since family caregivers play an important role in providing care for patients in need of palliative care, it is important to focus on and examine their care ability in fulfilling ...the expected roles. Therefore, this study aimed to perform a psychometric evaluation of the Caring Ability of the Family Caregivers of the Patients in Need of Palliative Care Scale (CAFCPNPCS).
Methods & Materials: The present study is methodological research that evaluates the psychometric characteristics of the CAFCPNPCS by measuring face validity, content validity, construct validity (confirmatory factor analysis and divergent validity), and internal consistency in 412 family caregivers of the patients in need of palliative care, who were selected through convenient sampling. The data were analyzed using SPSS 24 and LISREL 8.8.
Results: According to the confirmatory factor analysis, the 5-factor model with 31 items was confirmed with the values RMSEA=0.05, CFI=0.95, and GFI=0.88. The divergent validity was measured by the estimation of the correlation between the caring ability score with the care burden score (which was measured by Zarit Burden Interview) of the family caregivers of the patients in need of palliative care. Cronbach's alpha (α) was reported to be 0.85 for the whole scale and 0.781-0.852 for other dimensions.
Conclusion: CAFCPNPCS is a valid and reliable tool that can evaluate the caring ability of the family caregivers of patients in need of palliative care. Based on the results, it is recommended to utilize this scale to determine these caregivers’ ability to provide care and to examine the effectiveness of interventions to improve the dimensions of their caring ability.
The present study aims to explain and determine the use of integrative oncology from the perspective of the care providers in Iran.
This mixed-methods study is a convergent type of study with ...quantitative and qualitative phases that have been performed simultaneously. The quantitative phase was a descriptive study that was conducted through convenience sampling. With the use of a psychometrically evaluated questionnaire with 10 items, 202 nurses and physicians were included in the study to assess their views on the integration of traditional and complementary medicine (TCM) within supportive cancer care. The qualitative part of the study was conducted through semistructured interviews with 11 care providers. The interviews were analyzed through conventional content analysis and the method proposed by Graneheim and Lundman with the use of MaxQDA software.
After the quantitative and the qualitative data were combined, we identified four main categories as the important dimensions of using TCM: patients' main expectations of TCM services, reasons for using these services, existing challenges and barriers, and recommendations and strategies to improve the interaction between physicians and patients to facilitate the use of integrative oncology .
Although cancer patients use TCM due to a wide range of expectations, there are many barriers to integrative oncology in Iran. Therefore, it is necessary to pay attention to the benefits of conventional medical and TCM treatments, conceptualize integrative oncology, and try to meet the existing challenges.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background: Changes in the course of diseases, their treatment, and care provision result in the need for a specific type of care known as palliative care. Medical staff’s knowledge and awareness of ...palliative care is important in this regard. Objectives: This study aims to examine the caregivers’ knowledge and awareness of palliative care and to determine the related predictors. Methods: In this cross-sectional study, 277 subjects were selected from among the caregivers working in the selected teaching hospitals in Iran through non-randomized sampling method. The subjects were asked to fill the online questionnaire which consisted of 3 sections including demographic data, knowledge, and attitude toward palliative care. Descriptive, inferential statistics, correlation and regression analyses were performed. Results: The mean scores of care providers’ attitude and knowledge were 140.90 ± 11.56 and 19.36 ± 2.73 respectively. There was a significant relationships between some variables such as working place, education level, age, palliative care-related working experience, and the necessity to pass training courses and the mean scores of attitude and knowledge. Conclusions: Since palliative care providers’ level of knowledge and attitude were reported to be moderate, training courses at different levels in the form of clinical courses should be offered with the aim of improving care providers’ skills and scientific abilities. It is essential to include the related topics in the curricula of academic programs.
Insulin resistance (IR) and inflammatory mediators are correlated with hepatic fibrosis. Quercetin is a bioflavonoid with well‐known antidiabetic and antifibrotic properties. Bile duct ligation (BDL) ...is a surgical model performed on animals to produce a murine model in which increased oxidative stress occurs, which results in liver fibrosis. Our study aimed to determine whether quercetin improves hepatic IR as well as hepatic fibrosis in rats experiencing BDL. Male Wistar rats were allocated to four groups according to a random pattern, including a sham group, a sham and quercetin group (30 mg/kg/day), a BDL alone group, and a BDL and quercetin group (30 mg/kg/day). Evaluation of STAT3, SOCS3, IRS1, Rac1, Rac1‐GTP, Sp1, NOX1, HIF‐1α, and ERK1 expression was performed by RT‐PCR along with the western blot analytical technique in liver tissue. The antidiabetic impact of quercetin was associated with reduction in mRNA and expression of protein in STAT3 and SOCS3, along with an increase in IRS1. The antifibrotic effect of quercetin was also determined by downregulation of mRNA or the levels of protein expression of Rac1‐GTP, Rac1, HIF‐1α, NOX1, and Sp1, along with ERK1. Our study indicates that quercetin may improve hepatic fibrosis via inhibiting ROS‐associated inflammation as well as ameliorating hepatic IR by beneficial regulation of the STAT3/SOCS3/IRS1 signaling pathway.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Recent studies have strongly indicated the hepatoprotective effect of curcumin; however, the precise mechanisms are not well understood. This study aimed to determine the protective effect of ...curcumin on hepatic damage and hepatic insulin resistance in biliary duct ligated (BDL) fibrotic rat model. To accomplish this, male Wistar rats were divided into four groups (eight for each): sham group, BDL group, sham+Cur group and BDL+Cur group. The last two groups received curcumin at a dose of 100 mg/kg daily for 4 weeks. The mRNA/protein expression levels of Ras-related C3 botulinum toxin substrate 1 (Rac1), Rac1-GTP, dinucleotide phosphate oxidase 1 (NOX1), signal transducer and activator of transcription 3 (STAT3), suppressor of cytokine signalling 3 (SOCS3), insulin receptor substrate 1 (IRS1), extracellular signal-regulated kinase 1 (ERK1), specific protein 1 (Sp1) and hypoxia-inducible factor-1α (HIF-1α) were measured by real-time PCR and Western blotting, respectively. Fasting blood glucose, insulin and Leptin levels were determined and homoeostasis model assessment-estimated insulin resistance, as an index of insulin resistance, was calculated. Curcumin significantly attenuated liver injury and fibrosis, including amelioration of liver histological changes, reduction of hepatic enzymes, as well as decreased expression of liver fibrogenesis-associated variables, including Rac1, Rac1-GTP, NOX1, ERK1, HIF-1α and Sp1. Curcumin also attenuated leptin level and insulin resistance, which had increased in BDL rats (P<0·05). Furthermore, compared with the BDL group, we observed an increase in IRS1 and a decrease in SOCS3 and STAT3 expression in the curcumin-treated BDL group (P<0·05), indicating return of these parameters towards normalcy. In conclusion, Curcumin showed hepatoprotective activity against BDL-induced liver injury and hepatic insulin resistance by influencing the expression of some genes/proteins involved in these processes, and the results suggest that it can be used as a therapeutic option.
•The framework for developing NSRs in the health care system of Iran includes the following components: role titles, prioritization of the necessary specialties, the necessary competencies of nurses ...at specialist level, the scope of nursing specialist practice, expected authorizations, requirements for role development, and its barriers and facilitators.•This framework can be considered as the basis for developing the roadmap for NSR development in Iran. Such framework needs to be precisely described based on the characteristics of each country and its health care delivery system.•This study provides a deep insight into the framework for NSR development in the health care system of Iran. Policy-makers, decision-makers, legislators, and managers can use the results of this study to develop an appropriate roadmap for NSR development.•The NSR development framework developed in this study can be used in other countries for nursing specialization.•Developing NSRs can improve the quality and the efficiency of nursing care services and thereby, improve the quality of health care services.
A key step to the development of a roadmap for developing nursing specialist roles is to create its framework based on the immediate context.
This study aimed to create the framework for developing nursing specialist roles in the health care system of Iran.
This was a descriptive qualitative study. A purposeful sample of 81 nursing and nonnursing experts was recruited. The directed content analysis approach was used for data analysis.
The framework for developing nursing specialist roles in the health care system include eight main categories. These categories are role titles, prioritization of the necessary specialties, the necessary competencies of nurses at specialist level, the scope of nursing specialist practice, expected authorizations, requirements for role development, and its barriers and facilitators.
Creating a context-based framework for nursing specialist role development based on the characteristics of each country is recommended.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Curcumin is described as an antioxidant, hepato-protective and antifibrotic in liver fibrosis, although its mechanism is still not known. One of the models of the chronic liver disease stemming from ...oxidative stress and the generation of free radical has been considered to be bile duct ligation (BDL). Paraoxonase 1 (PON1) is a prominent antioxidant enzyme. Therefore, the objective of the present research is to assess the effects of curcumin on upregulation of PON1 in BDL rats.As predicted, the rats have been divided into the four groups of Sham, Sham + Cur (curcumin), BDL and BDL + Cur. We evaluated the efficacy of curcumin (100 mg/kg/day) on protein and gene expression of PON1 and regulatory genes contributed to the gene expression PON1 such as Sp1, PKCα, SREBP-2, AhR, JNK and regulation PON1 activity gene expression of Apo A1.Curcumin attenuated alterations in liver histology, hepatic enzymes and the mRNA expression of fibrotic markers (p<0.05). In addition, curcumin increased significantly mRNA, protein expression of PON1 and mRNA of the genes that are contributed to the expression of PON1 such as Sp1, PKCα, SREBP-2, AhR, JNK and increased PON1 activity through upregulation of Apo A1 (p<0.05).Cirrhosis progression may be inhibited by treatment with curcumin through the increased influence the expression and activity of PON1.
Multiple sclerosis is a chronic demyelinating disease of the central nervous system that can be exacerbated by obesity-induced systemic inflammation. Previous studies have shown that weight loss can ...improve symptoms of MS. Bariatric surgery and non-surgical methods, like diet therapy, are two common approaches to weight loss. In this systematic review, we have reviewed the effectiveness and safety of surgical and non-surgical methods for weight loss in MS patients. This systematic review was conducted based on PRISMA guidelines. PubMed, Embase, Cochrane, Scopus, Web of Science, Science Direct databases were used. Four articles on bariatric surgery and nine articles on diet therapy were included. Both bariatric surgery and diet therapy are safe and effective methods for weight loss in MS patients as in normal population, and both of them can improve quality of life without exacerbating disease progression. No major complications were reported. However, no studies directly compared these two methods and also there is uncertainty regarding long-term effects. Therefore more studies are needed to compare bariatric surgery with other weight loss methods and also to investigate the effect of these methods on more MS-related outcomes to determine the safest and most effective weight loss method in these patients.
Addressing the palliative care needs requires clinicians to have sufficient knowledge of and positive attitudes toward palliative care. The study aimed to determine nurses' and physicians' knowledge ...of and attitudes towards palliative care in Iran.
This descriptive cross-sectional study was conducted in 2021 on 493 physicians and nurses, selected through convenience sampling. Three online questionnaires addressing caregivers' demographic and professional's questionnaire, Health Care Providers' Attitude toward PC Questionnaire, and Health Care Providers' Knowledge of PC Questionnaire were used. The data was analyzed in SPSS using correlational and descriptive statistics and regression analysis.
The mean score of attitude towards palliative care was 142.03 ± 11.35 and the mean score of palliative care knowledge, 19.47 ± 2.62. Considering the regression coefficients between these two mean scores (P-value = 0.001, b = 1.304), it can be inferred that knowledge is a good predictor of attitude. In addition, the mean scores of knowledge and attitude have a significant relationship with age, female gender, holding a master's or PhD degree, the need for formal education in the field of palliative care and the need to take a palliative care course.
The present study showed that Iranian nurses and physicians have a moderate level of knowledge and attitude towards palliative care. It is necessary to take measures in order to improve knowledge and attitude by holding retraining courses, theoretical and clinical training sessions and relevant seminars in short term, and also by integrating related topics into nursing and medical curriculums in long term.
Background: Despite medical advancements and treatment development, children with cancer experience a wide range of symptoms related to the disease and treatment side effects. Providing palliative ...care is essential to improve the quality of life for both the child and the family. Given limited available resources, cost-effective service packages can address this need. Objectives: This study aimed to develop an essential palliative care package for children with cancer in Iran. Methods: The study was under Health System Research and employed an exploratory mixed method design in three phases. The initial stage involved two sub-studies including a review of literature and a qualitative study. In the subsequent phases, the package draft was compiled and validated using the Delphi technique with input from 12 experts. Results: The essential palliative care package for children with cancer comprised two main components: INPUT, including dimensions related to medicine, human resources, equipment, and service delivery setting. INTERVENTION, encompasses physical, psychological, social, spiritual symptom management, and growth and development. Conclusions: Customized for Iran's social and cultural context, this essential service package provides safe, efficient, convenient, and affordable care. Physicians and nurses with primary training can integrate it into primary care including home care, emphasizing the importance of palliative care.
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