Effectiveness of a standardized back school program for patients with chronic low back pain after implementation in routine rehabilitation care

ObjectiveTo evaluate the effectiveness of a standardized, patient-oriented, biopsychosocial back school after implementation in inpatient orthopedic rehabilitation.MethodsA multi-center, quasi-experimental controlled study of patients with low back pain (n = 535) was conducted. Patients in the control group received the traditional back school before implementation of the new program (usual care); patients in the intervention group received the new standardized back school after implementation into routine care. Patients’ illness knowledge and conduct of back exercises (primary outcomes) and secondary self-management outcomes and treatment satisfaction were obtained at admission, discharge, and 6 and 12 months after rehabilitation.ResultsWe found a significant small between-group intervention effect on patients‘ illness knowledge in medium- to long term (6 months: η² = 0.015; 12 months: η² = 0.013). There were trends for effects on conduct of back exercises among men (6 and 12 months: η² = 0.008 both). Furthermore, significant small effects were observed for treatment satisfaction at discharge and physical activity after 6 months.ConclusionsThe standardized back school seems to be more effective in certain outcomes than a usual care program despite heterogeneous program implementation.Practice implicationsFurther dissemination within orthopedic rehabilitation may be encouraged to foster self-management outcomes.     

The effectiveness of clinical pharmacist’s intervention in improving asthma care in children and adolescents: Randomized controlled study in Jordan

ObjectiveTo evaluate the effectiveness of clinical pharmacist’s intervention on achieving better asthma control, quality of life and other clinical parameters.MethodsA prospective randomized controlled study in north Jordan was conducted. Pediatric patients with asthma (aged 7–18 years old) were included and randomly allocated into two groups, intervention and control. Both groups were interviewed at the first visit and followed up twice by phone (at 3 and 6 months). Education was provided to patients and their caregivers in the intervention group only.ResultsOf 206 eligible patients recruited and randomized to our study, 178 patients completed the study (48.3% intervention versus 51.7% control). There were no significant differences in all baseline data between both groups. We identified significant differences in the improvement of asthma control (p < 0.001) and consequently pediatric and caregiver quality of life (p < 0.001) between both groups at the end of study. Significant differences were also detected in other clinical parameters (p < 0.05).ConclusionImplementation of clinical pharmacy service can positively influence asthma control, pediatric and caregiver’s quality of life, and other clinical parameters.Practice implicationsTo maintain a good asthma status, education of pediatric patients and their caregivers should be part of routine assessment during clinic visit.     

Implementation and evaluation of an integrated computerized asthma management system in a pediatric emergency department: A randomized clinical trial

ObjectiveThe use of evidence-based guidelines can improve the care for asthma patients. We implemented a computerized asthma management system in a pediatric emergency department (ED) to integrate national guidelines. Our objective was to determine whether patient eligibility identification by a probabilistic disease detection system (Bayesian network) combined with an asthma management system embedded in the workflow decreases time to disposition decision.MethodsWe performed a prospective, randomized controlled trial in an urban, tertiary care pediatric ED. All patients 2–18 years of age presenting to the ED between October 2010 and February 2011 were screened for inclusion by the disease detection system. Patients identified to have an asthma exacerbation were randomized to intervention or control. For intervention patients, asthma management was computer-driven and workflow-integrated including computer-based asthma scoring in triage, and time-driven display of asthma-related reminders for re-scoring on the electronic patient status board combined with guideline-compliant order sets. Control patients received standard asthma management. The primary outcome measure was the time from triage to disposition decision.ResultsThe Bayesian network identified 1339 patients with asthma exacerbations, of which 788 had an asthma diagnosis determined by an ED physician-established reference standard (positive predictive value 69.9%). The median time to disposition decision did not differ among the intervention (228 min; IQR = (141, 326)) and control group (223 min; IQR = (129, 316)); (p = 0.362). The hospital admission rate was unchanged between intervention (25%) and control groups (26%); (p = 0.867). ED length of stay did not differ among intervention (262 min; IQR = (165, 410)) and control group (247 min; IQR = (163, 379)); (p = 0.818).ConclusionsThe control and intervention groups were similar in regards to time to disposition; the computerized management system did not add additional wait time. The time to disposition decision did not change; however the management system integrated several different information systems to support clinicians’ communication.     

Impact of telephone counseling on the quality of life of patients discharged after coronary artery bypass grafts

BackgroundThis study aimed to assess the impact of telephone counseling on quality of life in patients with coronary artery bypass graft.MethodsA quasi-experimental study was conducted with 71 discharged patients after coronary artery bypass graft surgery at Ekbatan Edcuational hospital in Hamadan, Iran, in 2014. The patients were randomly allocated into intervention (n = 36) and control group (n = 35). The intervention group received education and counseling about therapeutic plan via telephone after discharge. Patients in the control group received only routines. All patients completed the quality of life questionnaire before and after the intervention period of five weeks.ResultsThere was no significant difference between intervention and control group about quality of life before intervention (p = 0.696). However, there was significant and positive deference between the two groups in favor of the telephone counseling after the intervention (P = 0.01) and control group (P = 0.04). Quality of life in the intervention group was significantly better compared to control group (P = 0.01).ConclusionsTelephone counseling could be a cost-effective patient counseling plan for therapeutic adherence after coronary artery bypass surgery in order to improve the patients’ quality of life.Practice implicationsTelephone counseling is feasible to implement and well accepted for patient counseling for many diseases.     

An asthma management system in a pediatric emergency department

IntroductionPediatric asthma exacerbations account for >1.8 million emergency department (ED) visits annually. Asthma guidelines are intended to guide time-dependent treatment decisions that improve clinical outcomes; however, guideline adherence is inadequate. We examined whether an automatic disease detection system increases clinicians’ use of paper-based guidelines and decreases time to a disposition decision.MethodsWe evaluated a computerized asthma detection system that triggered NHLBI-adopted, evidence-based practice to improve care in an urban, tertiary care pediatric ED in a 3-month (7/09–9/09) prospective, randomized controlled trial. A probabilistic system screened all ED patients for acute asthma. For intervention patients, the system generated the asthma protocol at triage for intervention patients to guide early treatment initiation, while clinicians followed standard processes for control patients. The primary outcome measures included time to patient disposition.ResultsThe system identified 1100 patients with asthma exacerbations, of which 704 had a final asthma diagnosis determined by a physician-established reference standard. The positive predictive value for the probabilistic system was 65%. The median time to disposition decision did not differ among the intervention (289 min; IQR = (184, 375)) and control group (288 min; IQR = (185, 375)) (p = 0.21). The hospital admission rate was unchanged between intervention (37%) and control groups (35%) (p = 0.545). ED length of stay did not differ among the intervention (331 min; IQR = (226, 581)) and control group (331 min; IQR = (222, 516)) (p = 0.568).ConclusionDespite a high level of support from the ED leadership and staff, a focused education effort, and implementation of an automated disease detection, the use of the paper-based asthma protocol remained low and time to patient disposition did not change.     

Evaluation of a computer-based bilingual breastfeeding educational program on breastfeeding knowledge,self-efficacy and intent to breastfeed among rural Hispanic women

ObjectiveTo evaluate the impact of an interactive, computer based, bi-lingual breastfeeding educational program on breastfeeding knowledge, self–efficacy and intent to breastfeed among rural Hispanic women living in Scottsbluff, Nebraska.MethodsA two-group, repeated measures quasi-experimental study was conducted to evaluate the impact of a breastfeeding intervention. Forty six rural Hispanic women between ages 18 and 38 years were enrolled at the Regional West Medical Center in Scottsbluff, Nebraska. Study participants were randomized into intervention and control groups, with the intervention group (n = 23) receiving bi-lingual (English and Spanish) breastfeeding education on a touch screen computer program, while the control group received printed educational material. Study participants were enrolled during their last six weeks of pregnancy, with follow up assessments conducted post-partum at days 3 and 7, weeks 2 and 6, and months 3 and 6. The study protocol was approved by the University of Nebraska Medical Center Institutional Review Board (IRB protocol #430-12-EP) and City University of New York Institutional Review Board (IRB protocol # 642980-1).ResultsA significant improvement in the breastfeeding knowledge and intent to breastfeed scores was seen over a 6 month period among all the study participants (p < 0.05). There was a gradual increase in the breastfeeding self-efficacy scores till week 6 followed by a decrease in self-efficacy scores at month 3 (p = 0.46), and month 6 (P = 0.54). Breastfeeding knowledge scores differed significantly between the study participants in the control and intervention groups at week 6 (p = 0.03). There were no significant differences in the breastfeeding knowledge between the control and intervention groups at other time points. The control group showed gradual decline in their self-efficacy scores at month 3 and month 6 compared to the intervention group that showed a gradual increase in their self-efficacy scores at different time points during their follow up period. However, there were no significant differences in the self-efficacy scores between the intervention and control groups at different points. The control group showed significantly higher negative breastfeeding sentiment scores compared to the intervention group at days 3 (p = 0.02) and 7 (p = 0.03) indicating a lower intent to breastfeed.ConclusionHispanic women living in rural settings showed improvement in breastfeeding knowledge, self-efficacy and intent to breastfeed using the computer based bi-lingual educational program. Results show week 6 and month 3 to be the critical time points of intervention so that women continue to breastfeed.     

Development and evaluation of a patient education video promoting pneumococcal vaccination

ObjectiveThis study aimed to develop and refine a patient education video about pneumococcal polysaccharide vaccination (PPSV23) and to assess patient perceptions regarding video content and receipt of video during a clinic visit.MethodsFocus groups were conducted to obtain patient feedback on a brief video focusing on personal susceptibility to pneumonia and highlighting the importance of both childhood and adult vaccines. Subsequently, interviews were conducted with patients ages 65 and 66 who were shown the revised video at an office visit. We assessed attitudes toward the video and perceptions about its presentation at the point of care. Participants responded to open-ended items as well as Likert-type items with responses from 1 (strongly disagree) to 5 (strongly agree).ResultsFocus group participants (n = 26) had positive reactions to the video, but suggested reducing the intensity of messages about pneumonia severity. Participants (n = 73) shown the revised video during a clinic visit perceived it to be easy to understand (M = 4.83, SD = 0.58) and informative (M = 4.8, SD = 0.75).ConclusionTarget audience feedback helped refine a video promoting PPSV23 vaccination; the video was well received by patients.Practice implicationsThis video may be an effective educational tool to increase rates of PPSV23 vaccination.     

IgE anti-respiratory syncytial virus antibodies detected in serum of pediatric patients with asthma

Respiratory syncytial virus (RSV) causes lower respiratory tract disease in infants and young children, and is a public health concern, as is the increase in pediatric asthma. Respiratory viral infections may trigger asthma exacerbations. However, it remains unknown whether RSV infection may have a specific association with asthma. Total serum IgE, and IgE- and IgG-anti-RSV Ab responses were studied in older asthmatic compared with non-asthmatic children (M/F, mean age: 14) (N = 30, N = 43, respectively). We found: (1) total serum IgE was higher in asthmatic compared with non-asthmatics (P < 0.001); (2) total serum IgE did correlate with IgE anti-RSV Abs (P < 0.001), and with IgG anti-RSV Abs (P = 0.008) in all subjects; (3) total serum IgE levels did correlate with IgE anti-RSV in asthmatics (P = 0.047), but not in non-asthmatics (P = 0.13); (4) IgE anti-RSV Abs did correlate with IgG anti-RSV Abs in all subjects (P = 0.001); (5) IgE- and IgG-anti RSV Abs were higher in asthma compared with no asthma (P = 0.003; <0.001, respectively); (6) there was a significant association between age and IgE anti-RSV in non-asthma (P = 0.008), but not in asthma (P = 0.64). Our findings indicate that IgE-anti-RSV Ab responses may play important roles in RSV infection and asthma.     

Patient knowledge and information-seeking about personalized cancer therapy

BackgroundUnderstanding patients’ knowledge and prior information-seeking regarding personalized cancer therapy (PCT) may inform future patient information systems, consent for molecular testing and PCT protocols. We evaluated breast cancer patients’ knowledge and information-seeking behaviors regarding PCT.MethodsNewly registered female breast cancer patients (n = 100) at a comprehensive cancer center completed a self-administered questionnaire prior to their first clinic visit.ResultsKnowledge regarding cancer genetics and PCT was moderate (mean 8.7 ± 3.8 questions correct out of 16). A minority of patients (27%) indicated that they had sought information regarding PCT. Higher education (p = 0.009) and income levels (p = 0.04) were associated with higher knowledge scores and with seeking PCT information (p = 0.04). Knowledge was not associated with willingness to participate in PCT research.ConclusionEducational background and financial status impact patient knowledge as well as information-seeking behavior. For most patients, clinicians are likely to be patients’ initial source of information about PCT. Understanding patients’ knowledge deficits at presentation may help inform patient education efforts.     

The association of health literacy and blood pressure reduction in a cohort of patients with hypertension: The heart healthy lenoir trial

ObjectiveLower health literacy is associated with poorer health outcomes. Few interventions poised to mitigate the impact of health literacy in hypertensive patients have been published. We tested if a multi-level quality improvement intervention could differentially improve Systolic Blood Pressure (SBP) more so in patients with low vs. higher health literacy.MethodsWe conducted a non-randomized prospective cohort trial of 525 patients referred with uncontrolled hypertension. Stakeholder informed and health literacy sensitive strategies were implemented at the practice and patient level. Outcomes were assessed at 0, 6, 12, 18 and 24 months.ResultsAt 12 months, the low and higher health literacy groups had statistically significant decreases in mean SBP (6.6 and 5.3 mmHg, respectively), but the between group difference was not significant (Δ 1.3 mmHg, P = 0.067). At 24 months, the low and higher health literacy groups reductions were 8.1 and 4.6 mmHg, respectively, again the between group difference was not significant (Δ 3.5 mmHg, p = 0.25).Conclusions/practice implicationsA health literacy sensitive multi-level intervention may equally lower SBP in patients with low and higher health literacy. Practical health literacy appropriate tools and methods can be implemented in primary care settings using a quality improvement approach.     

A brief dyadic group based psychoeducation program improves relapse rates in recently remitted bipolar disorder: A pilot randomised controlled trial

BackgroundVarious adjunctive psychotherapies assist in decreasing relapse and improving outcomes for people with bipolar disorder (BD). Psychoeducation programs involving patient-only or caregiver-only groups have demonstrated some efficacy. We tested in recently remitted BD if a combined group based psychoeducation program involving patient–companion dyads decreased relapse.Method58 recently remitted BD out-patients were randomised to receive either treatment as usual (TAU, n = 31) or 12 × 90 minute psychoeducation sessions delivered weekly in a group program to the patient and companion (SIMSEP, n = 27). After 12 weeks SIMSEP patients reverted to TAU and all patients were followed until week 60 or relapse. The primary outcome measure was relapse requiring hospital or intensive community intervention.Results45 patients completed the study. 29 patients remained well at week 60 (SIMSEP n = 17, TAU n = 12), whilst 16 had relapsed (SIMSEP n = 3, TAU n = 13). The SIMSEP group were less likely to relapse (Fisher's exact test p = 0.013; OR = 0.16; 95% CI 0.04–0.70) and had an 11 week longer time to relapse compared to the TAU group (chi-square (1) = 8.48, p < 0.01). At study completion SIMSEP compared to TAU patients had lower Young Mania Rating Scale scores (Mann–Whitney U = 255, p < 0.01).LimitationsThe study was limited by a small sample size.ConclusionA brief group psychoeducation program with recently remitted BD patients and their companions resulted in a decreased relapse rate, longer time to relapse, decreased manic symptoms and improved medication adherence suggesting utility in the adjunctive psychotherapeutic treatment of BD.     

MicroRNA–21 as a novel biomarker in diagnosis and response to therapy in asthmatic children

BackgroundThe underlying molecular mechanisms leading to asthma remain largely unclear. MicroRNAs (miRNAs) are short noncoding RNAs exert powerful effects on immunological function by tuning networks of target genes that orchestrate cell activity. However, the role of miRNAs, specifically microRNA-21 (miRNA- 21), in the regulation of allergic airway inflammation is not well defined. Our aim was to investigate the serum miRNA- 21 expression levels as potential biomarker in childhood asthma [with, without inhaled corticosteroid (ICS) therapy, and steroid resistant (SR)]; and their possible contributions in disease status, its molecular target interleukin-12 (IL-12) p35, and response to therapy.Materials and methodsThis study included 175 children; 95 were asthmatic patients subdivided into 3 groups [40 asthmatic children without ICS, 40 steroid sensitive (SS) asthma children and 15 steroid resistant (SR) asthma children] and 80 were healthy children as healthy controls. The miRNA-21 expressions levels were determined by quantitative real-time polymerase chain reaction (qRT-PCR) in all children. Serum IL-12p35 and total IgE levels were measured using enzyme-linked immunosorbent assay (ELISA).ResultsThe expression levels of miRNA-21 were significantly higher in the asthmatic children than in control group (P < 0.001); with significantly higher levels in asthmatic patients without ICS or in SR patients compared to SS children (P < 0.001). On contrast, serum IL-12p35 levels were significantly decreased in asthmatic patients without ICS therapy or in SR asthma patients as compared to SS patients (P < 0.001). Our data revealed that serum miRNA-21 expression levels was significant negatively correlated with serum IL-12p35 levels and FEV1, while it was positively correlated with both sputum and blood eosinophils. Importantly, serum miRNA-21 had a predictive value in differentiating SS from SR patients, with an AUC value of 0.99, specificity of 86.7%, sensitivity of 97.5% and P < 0.001.ConclusionThis study suggested that serum miRNA-21 is stable and detectable in serum of asthmatic children, which could promise potential biomarker in diagnosis as well as in response to therapy of asthma.     

Improving patient knowledge of palliative care: A randomized controlled intervention study

ObjectivesTo determine if laypersons’ knowledge about palliative care can improve with a brief education intervention.Methods152 adults were recruited to participate in a web-based randomized intervention trial that followed a 2 (content) × 2 (format) between-subjects design. Groups received either a video intervention, an information page intervention, a video control, or an information page control. An ANCOVA with contrast coding of two factors was utilized to assess if knowledge, as measured by the Palliative Care Knowledge Scale (PaCKS), increased post intervention.ResultsThere was a significant difference between intervention group means and control group means on PaCKS scores from T1 to T2 F(1, 139) = 11.10, p = 0.00, η_p² = 0.074. There was no significant difference in PaCKS change scores between the video intervention and information page intervention.ConclusionsThis study demonstrates that an information page and a brief video can improve knowledge of palliative care in laypersons.Practice implicationsSelf-administered educational interventions could be made available in diverse settings in order to reach patients and their families who may benefit from but are unaware of palliative care. Interventions more intensive than the one tested in this study might result in even more significant improvements in knowledge.     

Chlamydia pneumoniae enhances the Th2 profile of stimulated peripheral blood mononuclear cells from asthmatic patients

Chlamydia pneumoniae is a cause of respiratory infection in adults and children. There is evidence for an association between atypical bacterial respiratory pathogens and the pathogenesis of asthma. We compared T helper (Th) responses in C. pneumoniae – infected peripheral blood mononuclear cells (PBMC) in patients with or without asthma. PBMC (1 × 10⁶/mL) from asthmatic patients (N = 11) and non-asthmatic controls (N = 12) were infected or mock-infected for 1 h +/− C. pneumoniae TW-183 at a multiplicity of infection (MOI) = 1 and MOI = 0.1, or cultured for 24 h +/− Lactobacillus rhamnosus GG (LGG). Interleukin (IL)-4, IL-10, IL-12, Interferon (IFN)-gamma and total IgE levels were measured in supernatants (ELISA). C. pneumoniae infection led to an increase (>50%) of IgE levels in PBMC from asthmatics, compared with mock-infected on day 10; IgE wasn’t detected in non-asthmatics. C. pneumoniae – infected PBMC from asthmatics increased levels of IL-4 and IFN-gamma after 24 h, compared with PBMC alone; levels of IL-10 and IL-12 were low. When uninfected-PBMC from asthmatics were LGG-stimulated, after 24 h, IL-4 was undetectable, but IL-10, IL-12, and IFN-gamma increased, compared with PBMC alone. Thus, C. pneumoniae infection has the ability to induce allergic responses in PBMC of asthmatics, as evidenced by production of Th2 responses and IgE.     

CCR2-64I and CXCL12 3′A alleles confer a favorable prognosis to AIDS patients undergoing HAART therapy

BackgroundThe chemokine receptor polymorphisms CCR5Δ32, CXCL12 3′A, CCR2-64I and CCR5-59029 G/A have been demonstrated to affect HIV-1 infection and progression.ObjectiveWe studied the impact of the above polymorphisms on the effectiveness of a 30-month treatment with highly active antiretroviral therapy (HAART) in 149 HIV-1 patients.Study designWe stratified the patients according to CD4 CDC criteria and applied Kaplan–Meier analysis using the following end-point criteria: (a) the time from HAART initiation to undetectable viral load (VL) counts (VL < 50 copies/ml), (b) the duration of undetectable VL status and (c) the time required for CD4+ T-cell counts to pass over the 500 cells/ml threshold.ResultsOur results in the second group (CD4 201–500) revealed that patients with the CCR2-64I allele achieved undetectable VL counts at 3.5 ± 0.48 months as compared to 10.26 ± 1.42 months in the control group (p = 0.018). The VL remained undetectable for 28 ± 2 months, in contrast to 20 ± 2 months in the control group (p = 0.048). Patients carrying CXCL12 3′A restored the CD4 population faster than the control group (9 ± 2 and 14 ± 2 months, respectively, p = 0.023). The CCR5Δ32 and CCR5-59029 G/A alleles did not appear to affect the parameters studied.ConclusionsOur results suggest that patients carrying either CCR2-64I or CXCL12 3′A have a more favorable prognosis during HAART treatment.     

The role of patient education and physician support in self-efficacy for skin self-examination among patients with melanoma

ObjectiveThis project aims to elucidate the relationships between skin self-examination (SSE), perceived physician support of SSE, and self-efficacy for SSE among melanoma patients.MethodsA longitudinal study of patients diagnosed with melanoma was conducted over the span of 18 months. Participants filled out questionnaires at four assessment points and participated in an SSE education about the early signs of melanoma.ResultsAmong the 242 patients enrolled, the level of self-efficacy for SSE was 23% higher immediately after the educational intervention (p < .001) and the increase was retained three months (p < .001) and twelve months later (p < .001). Additionally, a one-way repeated measures ANOVA revealed that the perceived physician support of SSE positively corresponded to the level of patient self-efficacy with higher patient-reported physician support being related to higher self-efficacy (p = .001).ConclusionPatient education and perceived physician support of SSE are positively associated with patients’ level of self-efficacy.Practice implicationsPhysicians caring for melanoma survivors should be aware that, both SSE education and patients’ perception of high physician support of SSE may be associated with higher self-efficacy for checking one’s own skin for signs of cancer recurrence.     

The Effects of Focused Nursing Education on 3F Groshong™ PICC Occlusion Rates: The Experience of One Tertiary Pediatric Care Facility

ObjectiveThe primary aim of this project is to reduce the incidence of 3 Fr. Groshong? PICC occlusions through focused nursing education.BackgroundThe use of Peripherally Inserted Central Catheters (PICC) has become an essential tool in the care of pediatric patients. The small lumen and long length of PICCs requires specialized skill and knowledge in proper care, maintenance and flushing in order to prevent catheter occlusion and other complications. Occluded catheters compromise patient care and increase costs. Reducing the incidence of catheter occlusion, will have a significant impact on the quality of patient care; patient, family and nursing satisfaction, patient outcomes, and costs.MethodsA pre-test/post-test design using a convenience sample of all the core staff nurses working on the medical/surgical unit at a Southern California Children's Hospital was utilized. Objective measures included a written assessment of nursing knowledge, direct observations of nurses' flushing technique, and retrospective chart review to determine the rate of total catheter occlusion.ResultsMean written test scores improved from 0.78 to 0.93 (p = 0.00) Mean observation scores improved from 0.88 to 0.95, (p = 0.004). The pre-test occlusion rate was 21.11/1000 catheter days. The post test occlusion rate was 15.49/1000 catheter days (p = 0.057).ConclusionFocused nursing education contributed to reducing 3F Groshong? PICC occlusions and the associated costs due to PICC occlusions.     

An updated meta-analysis of transforming growth factor-β1 gene: Three well-characterized polymorphisms with asthma

The association between TGF-β1 polymorphisms and asthma risk has been widely reported, but results were controversial. We performed this meta-analysis based on the Preferred Reporting Items for Systematic Reviews and meta-analyses statement (PRISMA). Electronic database of Pub Med, Web of Science, CBM, and CNKI were searched for eligible articles published up to September, 2013. The effect summary odds ratio (OR) and 95% confidence intervals were obtained. Finally, a total of 20 articles were identified, 17 studies with 3694 cases and 5613 controls for C-509T polymorphism, 7 studies with 1109 cases and 1098 controls for T869C polymorphism and 5 studies with 849 cases and 829 controls for G915C polymorphism. For C-509T, significant associations with asthma were found in Asians (TT + TC vs. CC: P = 0.004, OR = 1.43, 95%CI = 1.12–1.81, P_{heterogeneity} = 0.001) and in Caucasians (P = 0.05, OR = 1.16, 95%CI = 1.00–1.34, P_{heterogeneity} = 0.36). With respect to T869C, a small significant association was observed in overall analysis of allele contrasts(C vs. T: OR = 1.14, 95%CI: 1.01–1.29, P = 0.03) and homozygote comparison (CC vs. TT: OR = 1.29, 95%CI: 1.00–1.65, P = 0.05), but no significant risks were found among Caucasian population and Asian population. For G915C polymorphism, no significant association with asthma risk was demonstrated in overall analysis and subgroup analyses according to ethnicity for all genetic models. This meta-analysis suggested that TGF-β1 C-509T and T869C polymorphisms may be risk factors for asthma.     

Impact of Tele-nursing on adherence to treatment plan in discharged patients after coronary artery bypass graft surgery: A quasi-experimental study in Iran

Background and aimsCoronary artery bypass graft is a major surgery and has complications that require professional and long term follow-up and nursing care that if do not properly handled, could reduce the quality of life and increase post-operative complications. On the other hand Tele-nursing is a cost-effective way to educate and follow-up of patients. This study aimed to assess the impact of Tele-nursing on adherence to treatment plan in discharged patients after coronary artery bypass graft.Materials and methodsA quasi-experimental study was carried out at Ekbatan Therapeutic and Educational Center of Hamadan University of Medical Sciences at Hamadan, Iran, in 2013. In this study, 71 patients who had undergone coronary artery bypass graft surgery and had inclusion criteria were randomly divided into two experimental group (n = 36), and control group (n = 35). They completed questionnaire before discharging from Therapeutic and Educational Center. In the experimental group on days 2, 4, 7, second week (day 11), third week (day 18) and fourth week (day 25) after discharge, follow-up interventions and nursing education with Tele-nursing was done, but in the in the control groups, patients received only routine interventions. After completion of the intervention period, both groups completed the questionnaire and the results were compared.ResultsAdherence of treatment plan in both groups did not have significant difference before intervention (P = 0.696), but had a significant difference with regard to baseline after intervention in aromatherapy group (P <  0.01) and with control group after intervention (P < 0.01). Adherence to treatment plan in the aromatherapy group was better in compared to control group (P < 0.01).ConclusionTele-nursing is a convenient way, cost effective training and follow-up care for patients after coronary artery bypass surgery, which can improve patients’ adherence to treatment plan in developing countries such as Iran.