Background: Diabetic foot ulcer (DFU) is one of the diabetes complications. DFU can be the cause of a high rate of amputation, health-care costs and even death, and this condition occurs in the severity status of DFU. Severity of DFU is the cause of expensive complication incidence. Understanding the factors affecting it can help preventive functions. Adequate evidence for this problem is necessary. The aim of this systematic review is to summarize evidence on severity of diabetic foot ulcer. Methods: A literature search was undertaken in Scopus, PubMed, Elsevier, MEDLINE, Embase, UpToDate and Google Scholar. Observational studies that assessed severity of DFU were included. The data extraction and assessment are on the basis of PRISMA. Results: Seven studies were assessed and 25 factors that affect severity of DFU are reported in the studies. The most used score for an estimate of severity was the Wagner scale (n=5). The majority of patients were in G1 and G2 stages (67.5%; basis of Wagner) or have a superficial ulcer (62.84%) on the basis of the Texas Diabetic Wound Classification System. The main factors include high BMI, smoking, lack of diabetes control, type of diabetes treatment and older age. In addition, there were other factors that affect severity of DFU such as vascular complications, bacteria isolated, marital status, gender, high levels of cholesterol and triglycerides. Also, life location, type 2 diabetes, genotype, addiction, long-time DFU and delay to refer patients were other factors. Conclusion: Twenty-five factors were reported. The majority of these factors related to life-style and can be prevented by self-care functions. The effect of these factors needs further study and the further studies must be better in quality.

Objective: Smoking is a risk factor for coronary artery disease (CAD) and a known factor influencing the severity and pattern of CAD. We summarized evidence regarding the effect of smoking on the number of occluded coronary arteries and the severity and pattern of CAD. Methods: We extracted data from observational studies reporting the pattern and severity of CAD in smokers. The quality of studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology checklist, and results are reported in the Garrard table. The review process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results: We screened 11 studies including 6037 samples. Six studies reported no relationship between smoking and the number of damaged arteries. One study reported that smoking was related to occlusion in the left anterior descending artery, but there was no relationship between smoking and the location of occlusion in the arteries. Smoking was related to CAD severity in five studies. Conclusions: Smoking was found to be related to CAD severity and location of the damaged artery in the heart. However, there was no significant association of smoking with the number of damaged arteries and location of arterial occlusion.

This study was performed with the aims of screening the previous studies on breaking bad news in all medical wards. Eligible observational studies were selected. The quality of the studies was assessed using the STROBE checklist. The findings were reported using Garrard's table. All the stages of the present study were performed in terms of the PRISMA statement. Totally, 40 articles were included in the study and 96 items were extracted. The results show that breaking bad news is a recipient-centered process. Respect, empathy, and support were reported. The news presenters are better to use guidelines based on evidence-based findings. It is suggested that the presenter should use simple and understandable content. Moreover, suitable time and space are important to present the news. The results show the importance of paying enough attention to the emotions of the recipient and the need to provide support after breaking bad news. The recipient must be the center of the programs. It is necessary to pay attention to the characteristics of the news presenter, the news content, and finally the support.Practice Implication: Understand the recipient, trained presenter, and use of the evidence-based results, improve the breaking bad news outcome.

Hepatitis is a complex and chronic liver disorder. Due to the nature of the disease, these patients experience various levels of social isolation, anxiety, and depression. Therefore, this study was conducted to evaluate depression, anxiety, stress, and social isolation in patients with hepatitis B and C in Kermanshah. This study is descriptive-analytic research, the participants were the patients with hepatitis, who referred to liver disease center. Data collection was with Russell social isolation questionnaire and DASS-21 questionnaire. The questionnaires were completed by the patients. 67.3% of the patients were male. The mean age was 41.02 ± 12.4 years, and the majority of the participants were married (143; 67.8%). The results showed that there is a direct and significant relationship between social isolation with depression, anxiety, and stress (P=0.001, P=0.001, P=0.001). In addition, results showed that there is a significant difference between the mean depression scores and age (P=0.048). Also, the results showed that there is a significant difference in the mean score of social isolation and education level (P=0.038). There is no significant difference between the other variables with depression, anxiety, stress, and social isolation (P>0.05). These results showed that there is a relationship between social isolation with anxiety, stress, and depression. Also, anxiety, stress, and depression in hepatitis patients are related to age and education level. So, it is suggested to provide effective programs in the care of these patients. Doi: 10.28991/SciMedJ-2020-0204-5 Full Text: PDF