Management of chronic diseases is a challenging task in current medical practice and treatment of such conditions and their complications is not very straight forward as we deal with multiple clinical problems. This review article provides an overview of the core concept of patient-centered care, effects of diabetes mellitus (DM) on wound healing, and implication of the multidisciplinary team concept for such patients. The literature was searched using “wounds”, “chronic wound healing”, “multidisciplinary team and chronic wound healing” and “patient-centered care and wound healing” as keywords on PubMed as the main source of search. Every chronic disease can involve many health professionals at various stages. The patient-centered approach is a concept that is proving beneficial clinically. This concept considers patient as a center of the circle, and every facility is connected and based upon the patient’s needs. In this article, we have briefly explained implication of such multidisciplinary teams by considering DM management, with a focus on chronic wounds. DM is one of the systemic diseases which puts a significant financial as well as health quality related burden on health systems worldwide. Out of these complications, diabetic foot ulcers (DFUs) and effects of DM on wound healing are extremely important. This clinically important concept of making “teams” to manage various chronic diseases should be investigated in various clinical settings. The data from further research should be analysed to standardize this globally for different categories of wound patients.

BACKGROUND: Type 1 diabetes is one of the most common chronic diseases in children. Metabolic control and following diet therapy in teenagers with type 1 diabetes are weaker than children before the adolescence stage. One of the most important factors influencing self-management seems to be spiritual intelligence. The aim of this study was to investigate the relationship between spiritual intelligence and self-management in patients with diabetes. METHODS: The population of this descriptive cross-sectional study consisted of all adolescents with type 1 diabetes referring to the clinic of Tohid Hospital in Sanandaj, Iran, which were 194 people. Data were collected by interview and using a questionnaire. Sampling method was available or simple sampling. The collected data were analyzed using descriptive statistics and SPSS software. RESULTS: The majority of people were in the middle period of adolescence. More than half (88.5%) of them had a moderate and good economic situation and the majority of them (62.5%) had a history of diabetes in the family. Most of the people (56.5%) had an average duration of diabetes. More than half of the subjects were the first and second children of the family. CONCLUSION: The results showed that self-management increased with increasing spiritual intelligence of individuals, and with decreasing spiritual intelligence, self-management decreased; in other words, there was a positive and significant correlation between spiritual intelligence and self-management.

BACKGROUND: A transtheoretical model (TTM) can be considered as a cognitive and motivational view, a component which plays a significant role in addiction. Further, the theoretical basis of contingency management (CM) treatment is the origin of behaviorism and relies on operant conditioning. The present study is performed aiming to determine the effectiveness of TTM and CM on cocaine use and sexual risk behaviors in cocaine users. METHODS: In this randomized clinical trial with 6-month follow-up, which was performed from 15 December 2014 to 20 November 2015, 75 male cocaine users were selected based on a respondent-driven sampling (RDS) method and were randomly divided into three groups by block randomization. The experimental group received a 12-week CM protocol and TTM and the control group was placed on the waiting list. Pre-test, post-test (after 12 weeks of training), and follow-up (six months) were administered. Data analysis was carried out using repeated measures analysis of variance (ANOVA), Scheffe’s post hoc test, and chi-square test through SPSS software. RESULTS: The mean age of the CM group, TTM group, and control group was estimated 26.12, 25.31, and 23.91, respectively. The primary outcome showed that CM and TTM had a significant effect on decreasing the sexual thoughts, sexual hyperactivity, and high risk behaviors. This effectiveness was stable until six months (P = 0.008), however there was not a significant difference between the two treatments (P = 0.200). The secondary outcome showed that in the changing stages, TTM (F-72%) and CM (F-60%) had a significant effectiveness which maintained until the follow-up stage. CONCLUSION: The findings more enhance the hope to integrate the theoretical approaches into the clinical interventions.

BACKGROUND: The positive effects of antioxidants in preventing atrial fibrillation (AF) after cardiac surgery and their low side effects have been proven. The aim of this study was to evaluate the effect of oral vitamin C supplementation on preventing post-operative AF in patients undergoing coronary artery bypass graft (CABG) surgery. Vitamin C was given orally to the patients three days before surgery for up to 5 days after surgery. This time difference was based on previous studies and cardiologist’s order. METHODS: In this study, patients who underwent CABG surgery, were divided into two groups. The first group (30 patients), as the intervention group, received oral vitamin C supplementation, and the second group (30 patients), as the control group, did not receive vitamin C supplementation. All patients, during the post-operative period, underwent cardiac monitoring in cardiac intensive care unit (CICU). The inclusion criteria were: being over 50 years old, undergoing cardiac surgery only and no other kinds of surgery, undergoing coronary artery bypass surgery for the first time, and no cardio-respiratory arrest during or after surgery. Data were collected by convenience sampling method and were analyzed using SPSS software. RESULTS: The results of this study showed that 7 patients in the control group experienced post-operative AF, while 3 patients in intervention group had the same experience. According to the results, the risk of AF in the intervention and control group was, respectively, 10.0% and 23.3%. Vitamin C significantly decreased the risk of AF after CABG surgery by 2 times. CONCLUSION: According to the results, oral vitamin C supplementation affected the incidence of AF after CABG surgery. Therefore, oral intake of vitamin C supplementation before and after surgery reduces the incidence of AF.

BACKGROUND: Brucellosis is a common widespread zoonotic disease between humans and livestock with significant economic and health problems caused by various species of Brucella . The disease is a significant public health issue throughout the world and one of the most socioeconomic problems in many developing countries. This study aimed to report the information available at the Provincial Health Center about the frequency and characteristics of patients with Brucellosis in Golestan Province, Iran. METHODS: This study was analytic-descriptive cross-sectional. The study population included all patients with Brucellosis diagnosed from 2011 to 2015 in the health center of Golestan Province, based on the serological method. The data gathering tool was a questionnaire that included demographic information, clinical presentation and examinations, history of exposure, laboratory findings, and treatment protocols. Descriptive statistics were reported as frequency and mean ± standard deviation (SD) and analyzed by SPSS software. RESULTS: In this study, a total of 1788 cases of Brucellosis were reported. The number of male cases was 1163 (65.04%) and female cases were 625 (34.95%). People who had a history of contact with infected animals were younger than the others. Musculoskeletal pain (79.69%) and fever (76.45%) were the most commonly reported clinical symptoms. CONCLUSION: Overall, the results indicate that Brucellosis is still a health problem in the province. The high incidence of Brucellosis in villages, the lack of full coverage of animal vaccination, and the link between the disease and livestock businesses are significant.

BACKGROUND: Treatment-resistant depression (TRD) is a severe and chronic form of major depression. It poses significant clinical, personal, and economic burden and does not respond to antidepressants. Psychotherapy can be a suggested option. The aim of this study was to survey the effectiveness of cognitive behavioral therapy (CBT) on patients with TRD. METHODS: The present study was a quasi-experimental study with pretest, posttest, and follow-up. The statistical population included patients with TRD in Rafsanjan City, Iran, in 2018. 30 subjects were randomly selected and placed into experimental and control groups. Data were collected by Beck Depression Inventory (BDI), Rumination Questionnaire, and Brunel Mood Scale (BRUMS). To analyze data, multivariate analysis of covariance (MANCOVA) was used with SPSS software. RESULTS: CBT led to reducing depression and rumination and improving mood and this outcome was better than control group (P < 0.05). CONCLUSION: TRD is a chronic and disabling disorder that little research has been done about its treatment. CBT can be a good treatment offer for TRD.

BACKGROUND: In the hospital, nurses are exposed to high levels of psychological stress. The purpose of this study was to compare the quality of life, psychological well-being, and emotional self-regulation of nurse and non-nurse women in Imam Khomeini hospital in Koohdasht City, Iran. METHODS: This was a descriptive prospective causal-comparative research. The statistical population of this study was all the women staff of Imam Khomeini hospital in Koohdasht in 2018. A sample population of 100 nurse women was selected using convenience sampling method, and 100 non-nurse women were selected via random sampling method. The instruments used in this research were 36-Item Short Form Health Survey (SF-36) Quality of Life, Reef Psychological Well-Being, and MARS emotional self-regulation questionnaires. Data were analyzed using multivariate analysis of variance (MANOVA) (P < 0.050). RESULTS: The MANOVA test showed a significant difference between quality of life, psychological well-being, and emotional self-control between nurse and non-nurse women (P < 0.050). This meant that nurse women in the studied variables were lower than their non-nurse counterparts. CONCLUSION: According to the results of this research, it is suggested that in nursing mental health promotion programs, education should be considered in order to improve the quality of life, psychological well-being, and emotional self-regulation of nurses.

BACKGROUND: Pulmonary arterial hypertension (PAH) is a progressive disorder and a newly-discovered disease in people with end stage renal disease (ESRD). In patients who are hemodialyzed through arteriovenous fistula (AVF), the incidence of pulmonary hypertension (PHT) is highly probable. Regarding the main role of the AVF in the pathogenesis of PAH and the fact that AVF is the main method of vascular access in patients undergoing dialysis, we decided to investigate pulmonary artery pressure (PAP) in patients under chronic hemodialysis. METHODS: This was a cross-sectional study. All patients with chronic hemodialysis were divided into two groups according to the status of the fistula. The number of cases examined included 100 patients and data were analyzed by SPSS software. RESULTS: The most common cause of ESRD was hypertension (HTN) followed by diabetes mellitus (DM), polycystic kidney disease (PKD), urologic disorders, DM and HTN, combined blood pressure (BP) and PKD, renal stones, and other items ultimately. The average creatinine level was 8.59 mg/dl. Therefore, the mean creatinine level of patients, although relative to mode and median, was in any case significantly higher than the mean, which was predictable according to the ESRD community studied. The mean phosphate level was 5.66 mg/dl, and the mean hemoglobin (Hb) was 11.56 g/dl. The mean parathyroid hormone (PTH) and PAP were 558.68 and 27.33 mmHg, respectively, and the mean of ejection fraction (EF) was 50.75%. There was a significant difference between the mean PAP in the two groups (P = 0.048), as it was higher in the AVF group. CONCLUSION: Results of this study showed that AVF and ESRD both were risk factors for high PAP and PHT.