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Background and purpose: Retinopathy of premature neonates (RÔP) is a lesion in the retina of under weight neonates at birth, which can lead to blindness. Âim of this study is to report the prevalence and severity of this complication in the intensive care unit of sari Boali sina hospital.
Materials and methods: Ïn this descriptive- cross sectional study which was followed by clinical examinations, laboratory findings and by referring to the filled questionnair, 68 neonates met the necessary criteria, were selected. Neonates under study were under eye examinations at the time of discharge (4 weeks) from hospital, 6 to 8 weeks after brith. Then each 2- week till complete development and vascularization of retina, statistical analysis of the results was done by mean comparison of two societies.
Results : Prevalence of RÔP was generally 11.7 % and severity of RÔP at stage 3 or greater was 1.4 % . No case of RÔP at gestational age of more than 34 weeks was observed. Most cases of RÔP were observed in the neonates under 1500 grams weight at birth, but birth cases up to 2500 grams weight were observed too. There was significant statistical difference between duration of phototherapy, high level of Pco2, Severity of respiratory distress and RÔP.
Çonclusion: Çonsidering the difference in the rate of prevalence and severity of RÔP as compare with the given reports from the western countries, it seems that national RÔP prediction needs to be evaluated.

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Background and purpose : Health care workers (HCW,s) are at increased risk of hepatitis viruses infection .Seroprevalence rates of hepatitis B and C viruses ( HBV,HCV) are higher among HCWs .Universal precautions to prevent the transmission of infections during medical cares along with vaccination are recommended or even mandatory in most countries. The purpose of this study was to determine the seroprevalence of anti-HAV , anti–HCV ,and anti-HBs antibodies,and HBV vaccination status in a general teaching hospital HCWs in Sari-Iran .
Materials and methods : Between June to October 2003, questionnaire was used, data extracted from medical records, and serology by ELISA method for anti-HAV, anti-HBs anti-HCV, and-HBs-Ag in those HCWs with negative anti-HBs. HBV vaccination status were recorded . Seroprovalence rates of HBs-Ag and anti-HCV antibody were compared with those detected in blood donors during the same period.
Results : Totally 263 HCWs and 17 kitchen staff were participated in the study. Anti –HAV, anti-HBs , anti-HCV ,and HBs-Ag were detected in 90.36% ,87.5% ,0.37% and 0.74% of the subjects respectively. HBs-Ag and anti-HCV were detected in 4.8% and 0.83% of blood donors, respectively. 61.9 % of HCWs completed their HBV vaccine series and 72.7% of non-vaccinated HCWs developed anti-HBs antibody.
Conclusion : These data showed that the prevalence of HBs-Ag and anti-HCV in HCWs was lower than general population. HAV infection was hyperendemic. HBV infection was higher among non-vaccinated personnel, and more than 1/3 of HCWs did not complete their vaccination, so, mandatory HBV vaccination, is recommended.

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Background and purpose: Ïntensive care unit is a subspecialty ward that manage critically ill patients. Scoring systems have been developed in intensive care medicine to predict the outcomes of patients admitted with severe illnesses resulting in significant mortality rates as well as to improve resource allocation and to assist in clinical decision-making. This study was conducted to determine how multiple organ dysfunction score (MÔDS) would predict outcome and mortality of critically ill patients.
Materials and methods : This was a prospective, observational and cohort study. Ône hundred patients who underwent mechanical ventilation in 2004 in the general ÏÇÜ of Ïmam Khomeini hospital center were induded in the study. Ëach component score provides a quantitative measure of physiologic function over 24 hours, such that zero represents normal function, and 1,2,3, and 4 represent increasing physiologic derangement. Data were collected prospectively using forms and analyzed.
Results : The mean age of the patients was 48.63 years. The mean age of patients were 41.66±16 in discharge patients and 55.6 ± 17 in dead patients. Mean discharge scores have been less than mean dead scors. Mean change scores have been reduced in comparison with baseline score (P<0.05).
Çonclusion : Ôur study showed that MÔDS have significant correlation with prediction of mortality. Â significant correlation between age and mortality was also noted. Ït means that the mortality increases with age as mean change scores have been reduced in comparison with baseline (P<0.05). The results indicate that therapeutic measurement was effective in correlation with indicidual score.

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Background and purpose: Anesthesiologists have become the first priority since they can play an important role in crisis situations to support respiratory and cardiac urgencies. In this survey, the effects of the resident anesthesiologists were studied on the death of patients having been hospitalized in the Intensive Care Unit of Imam Khomeini training and treatment center, Sari from 2000 to August 2004.
Materials and Methods: In this survey, the subjects of the "case group" (passed-away patients during the residency of the anesthesiologist) have been compared to the subjects of the "control group" (having no resident anesthesiologist). The following variables were considered for analysis: age, gender, hospitalization reasons, the original ward, reason of and the service of reference to the Intensive Care Unit, the cause of death, hospitalization period in the original ward and Intensive Care Unit, as well as the number of the visits paid by anesthesiologist. Other interfering variables (such as facilities) were not taken into account, since they had been the same for both groups. Data were analyzed using the SPSS software and the descriptive and analytical (X2,Z,T) statistical tests.
Results: The findings of this survey showed that men have died more than women (61.9% vs 38.1%) in the intensive care unit. The total hospitalization period reduced from 14 to 11 days, having an anesthesiologist residing in this ward. It was revealed that the presence of an anesthesiologist reduced the death rate from 24% to 14%.
Conclusion: According to the findings of this survey, it has been revealed that the presence of an anesthesiologist can have an outstanding effect on the reduction of the death rate. It is taken for granted that choosing patients must be done in accordance with Classic Indications since there are limited number of beds in ICU and the admission request for different patients. In equal situations, those patients who have better opportunity and less mortality probability and better prognosis in this unit have priority.

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Background and purpose: The aim of this study was to determine the incidence and presence of a relationship between predictors of body mass index (BMI) or C-reactive protein (CRP) and duration of mechanical ventilation, in trauma patients who were admitted to the intensive care unite (ICU). Furthermore, we compared their prognostic significance, with known indicators such as, the Sequential Organ Failure Assessment (SOFA) score.
Materials and Methods:This prospective observational study was preformed on 72 admitted critically ill trauma patients in a general ICU setting, in Alzahra Medical Center of Isfahan University. Patients were categorized by duration of mechanical ventilation to the group A (≤ 7 days) and group B (> 7 days). The severity of illness was assessed by the Revised Trauma Score (RTS) calculated on the first admission to the ICU unit. The biological status of the patients was assessed by the serial measurement of CRP on admission to ICU (T1), at 48, 72 hours subsequently, and on the beginning day (T2) or discontinuation (T3) from mechanical ventilation. Data on BMI, serum albumin, and the SOFA score, were also collected on T2 and T3.
Results:There was no significant difference between two groups in demographic characteristic or RTS.On T3, the SOFA score, BMI, albumin, and CRP were significantly higher within group B patients, as compared with group A (P < 0.01). The incidence of low BMI (≤ 20 kg/m²) or high CRP (> 10 mg/L) on T2 was 72.2% (52/72) and 81.9% (59/72) respectively. The incidences of low BMI or high CRP in group B patients were significantly higher on T2 or T3, as compared with group A (P < 0.05). CRP or BMI on T3 had high specificity for predicting more than seven days of MV. On T3, the SOFA score, serum albumin, CRP, and BMI provided significantly good discrimination (area under curve > 0.5) in descending order. Mean serum CRP level within 72 hours after admission to the ICU or on T3 was significantly more in group B patients, as compared with group A (P < 0.01). The most significant predictor more than seven days of mechanical ventilation was CRP followed by BMI on T3.
Conclusion:Both the BMI and CRP comparables with the SOFA score can be used in estimating the risk of prolonged mechanical ventilation. It is also concluded that maintaining the level of BMI or CRP in normal range, could shorten the duration of mechanical ventilation.

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Background and Purpose: Malnutrition is a major problem within intensive care units (ICU) affecting the outcome of patients. In Imam Khomeini Hospital, patients were fed with gavage solutions prepared in the kitchen of hospitals, however, its' nutritional value has not been studied at present time. The aim of this study was to analyze the gavage solution and to compare the calculated nutritional demand with the provided values.
Materials and Methods: The amount of carbohydrate, lipid and protein of gavage solution has been determined with Leen ion, Gerber and Kejeldal methods, respectively. In this study, 30 patients with at least 5 days in the ICU were included. Daily metabolic needs were calculated with Harris-Benedict equation and then, calculated calorie and protein values were compared with the provided values.
Results: The carbohydrate, lipid, protein and energy contents of gavage solutions were 0.035 ±0.002 g/ml, 0.0225±0.017 g/ml, 0.012 ± 0.002 g/ml, and 0.39 ± 0.164 Kcal/ml. The calorie and protein provided by the hospital solution, in comparison to the standard enteral solutions, were 32.5% and 16% respectively. Total energy expenditure (TEE) at the time of admission to ICU was 2302 ± 633 Kcal/ per day. During week 1, 2, and 3, TEE was 2301±634, 2283 ± 661 and 2228 ± 790 respectively. Maximum provided energy was 600 ± 632 Kcal/ per day. Maximum protein was provided in week 3 and equal to 22.9% of patient’s needs.
Conclusion: The gavage solution provided by hospitals can not meet the calorie and protein needs of patients. It is necessary to prepare solutions with enough contents of carbohydrate, lipid and protein or to provide them with standard enteral nutritional solutions.

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Background and purpose: Diabetes type 1 is a chronic disease in children during their childhood, which may have unfavorable effects on children, family and society. By enhancing self- care in children having diabetes type 1, we can reduce these effects. Self- care in children also can be affected by factors such as family reaction. The purpose of this research is to determine the relationship between self-care in diabetic children and their family’s reaction.
Materials and methods: This research is a non- experimental and correlative study which determines and specifies the relationship between diabetic self- care in children, who are affected by diabetes and their family’s reaction. 133 children between the ages of seven to fourteen suffering from diabetes type 1 were chosen with above continuous method for two months from selected centers. Collecting information, observation and questionnaire forms were used.
Results: The results obtained from this study, showed there is a meaningful relationship between child's self- care and reaction of their family (p=0.000). Variants such as age, sex, rank of birth and length of disease period are not considered as an interfering element in relation between self caring and family reaction.
Conclusion: The results from this research reveal that the self caring of children in an average level has a direct influence and relationship with family reaction and at the same time, the direct and strong correlation with the diabetic child’s knowledge regarding their functions and performances. We suggest that educational programs should be provided for these children and their families, in order to promote self caring of children and their family’s reaction. We also propose conducting similar research, by using case- control method, to identify other factors in this regard.

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Background and purpose:Weight-based dosing of medication is used in theemergency and anesthesia departments.Ideally each patient should be weighed prior to dosing. However, this may not always occur, especially in the anesthesia department. The purpose of this study was to assess the prediction formula for actualpatient weight by the sum of head weight and estimated Anesthetic personnel.
Materials and methods:Diagnostic descriptive study was used for patient’s body weight, which had been estimated by anesthetic personnel's, while head patient weight was measured by instrument during anesthesia. Data was analyzed by descriptive statistics and regression linear and compared with ANOVA test. The significance level in this study was.
Results:The mean total weight of patients that were estimated by the personnel of anesthesia was 65.7±11.7 kg. The mean actual weight was 65.2 ± 13.7 kg. The correlation coefficient between estimated actual weight is not significant.
Conclusion:This study showed that adding head weight to the estimation weight by anesthetic personnel, results in a more accurate weight estimation than head Wight alone.

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The genus Aspergillus is ubiquitous filamentous fungi with a wide distribution in nature. The species of Aspergillus are associated with a varied spectrum of diseases including allergy, superficial colonization and invasive infection in humans. Invasive aspergillosis (IA) is a serious and fulminate mycosis in immuno-deficient individuals. Over the last decade, IA has also been reported as a fungal infection in critically ill patients, admitted to ICU with high morbidity and mortality rate. However, long term admission in ICU, treatment with immuno-suppressive agents caused by increasing incidence of IA in the ICU. It is expressed that delay in proper diagnosis, no timely treatment and the presence of different underlying diseases and neutropenia are the important reasons of high mortality in these patients. In spite of advances in diagnosis and treatment of IA, it appears that the occurrence of IA in ICU patients is due to lack of estimation and proper diagnosis of disease. In addition to traditional methods, using the specialized methods such as PCR, evaluation of serological markers including Galactomanan and β-D Glucan in different types of specimens, is necessary to show the true rate of IA risk in ICU patients and also to have a proper program for hygienic and preventive actions. Along with the increase in the number of ICU units comes a surge in admission of patients in these centers, but because there was no such study in Iran, we reviewed the papers in this field to consider different aspects of IA with emphasis on diagnostic methods.

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Background and purpose: Medication errors today are discussed as one of the main concerns of the health care systems and are used as an indicator for determining the level of patients safety in hospitals. This study was conducted with the purpose of evaluating medical errors among intensive care nurses. Materials and methods: In this descriptive study the research population composed of nurses working in intensive care units of Imam Khomeini Hospital Complex, Tehran, 2011. 64 nurses were randomly selected and asked to answer to a researcher made questionnaire. The data was analyzed by SPSS version 16 using descriptive and inferential statistics. Results: 73.43%, 42.55% and 57.45% of nurses reported the occurrence, verge of occurrence and not occurrence of medical errors, respectively. The most common type of medication errors were infusion rate and doses of drugs due the drug’s abbreviated names and existence of similarities among drug's names. The most important causes of medication errors were lack of pharmacological information. Conclusion: Since the risk of medication errors among nurses is high, therefore, retaining courses on pharmacological information, modification of educational curriculum, encouraging nurses to report medical errors and also encouraging hospital managers to give positive response to errors are suggested.

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Background and purpose: Caring as the core concept of nursing, have been defined in different ways since the past, yet it remains an abstract concept in nursing practice. There are many discussions and challenges between scientists in nursing and so far few researches were carried out on this concept. The purpose of this study was to identify how nursing care is conceptualized by nurses in Iran, and to develop guidelines for clinical practice. Materials and methods: This study employed the hybrid model to define the concept of care through 3 phases. For the theoretical phase attributes of care were identified through a review of the literature (until 2011), and in depth interviews were conducted for the fieldwork to develop attributes from the data and to verify those identified from the literature review. In third phase attributes and final analysis of care were extracted from the first and second phase. Purposive sampling was done for 20 participants (16 nurses and 4 faculty members. Results: Core attributes of care include assessing patients' needs, altruism, duty responsibility, routine and participating in religious activities. However, core attributes of a good nurse who cares a patient includes creativity, responsibility, being decisive, capable of establishing effective relationship, and skillful in practice. Conclusion: It seems that the result of this study somewhat assisted in clearing the concept of care. This may result in providing the patients with care based on their needs, their satisfaction, professional development and reduction of health costs. Moreover, by identifying the facilitating and preventive factors, and the concept of care, nursing managers and instructors will be able to design and run their management and educational activities based on scientific findings which could provide the necessary conditions for learning and proper implementation of nursing care.

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Background and purpose: Shivering is a common and unpleasant side effect in post operation which is associated with other complications such as increased demands for oxygen, tension on suture line and increase of Ïntra Çranial Pressure. The purpose of this study was to compare the effects of tramadol and pethidine in controlling post operative shivering.
Materials and methods: Â randomized controlled trial was carried out on 50 patients (aged 20 to 40 years) who were referred to operation room for general surgery or orthopedic surgery. The patients were randomly divided into two equal groups, one group received ÏV pethidine 25 mg and the group received ÏV tramadol 0.5 mg/kg. Post operative shivering was assessed by direct observation.
Results: There was a significant difference between the two groups in elapsed time to control of shivering (p=0.016). Vomiting was not seen in the both groups. Ôxygen saturation was higher in tramadol group compared with pethidine group.
Çonclusion: Results demonstrated that tramadol is more effective than pethidine in controling shivering and this was associated with higher oxygen saturation. Ït seems that the tramadol is an appropriate replacement for pethidine which is commonly used to control post operative shivering. Further studies with more samples are recommended.

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Background and purpose: From the second half of 2005, family medicine as reform in primary health care sector was introduced for all rural as well as towns with less than 20000 population in order to improve the performance of this system particularly curative care. In this reform both the method of employment and the payment mechanism that could potentially change the performance of family medicine team were changed. In this paper change in the performance of health centers in ambulatory care before and after the implementation of reform in two cities (Mazandran province) is compared. Materials and methods: This investigation includes two case studied in two cities. Data of 30 rural health centers in Sri and 12 in Joybar were gathered. The collected data were based on existing data of Iran’s primary health network information system. A check list was used for data collection. These data were related to one year before the implementation of scheme and three years after the date that the scheme was started. Results: A substantial increase in the number of patients visited by physician had happened that is about 6 times higher than their performance in the same centres before the reform. A change of about two times increase in the provided services of lab and injection and wound dressing unit had also happened. Conclusion: In this study, health care providers of health centres under the same conditions of primary health care delivery behaved differently so that their performance improved about 6 times compared to prior the reform. The changes, with fewer slopes, were seen on other curative care including lab and injection and wound dressing services.

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Background and purpose: Hospital-acquired pneumonia (HAP) is the most commonly-acquired infection in patients in intensive care units and related to a high mortality rate. Due to differences in type of microorganisms and their resistance pattern, this study was conducted to determine profile of microorganisms and their resistance pattern for initiation of more effective empirical therapy. Materials and methods: All patients admitted to three intensive care units (ICUs) of Imam Khomeini Hospital between January 2011 and August2012 were studied prospectively for the occurrence of Sample collection for microbiological analysis was done by ETA ((endotracheal aspiration)) and BAL (bronchoalveolar lavage) methods. Antimicrobialsusceptibility test were determined by “Disk Diffusion” and “Broth Dilution”methods according to CLSI (Clinical and Laboratory Standards Institute) guidelines. Results: Three hundred and eight patients from three ICUs were included in the study. Incidence of nosocomial pneumonia was 11.4%, including 91.4% VAP (ventilator-associated pneumonia) and 8.6% Non-VAP. The most common microorganisms isolated wasAcinetobacterspp (22%) and Staphylococcus aureus (14.6%), respectively. Thirty percent of Acinetobacterspp were resistant to all antimicrobial agents. Ceftazidime was the most effective antibiotic (rate of Resistance 22.2%). All isolated Acinetobacters were resistant to ciprofloxacin and ceftriaxone. Regarding the Staphylococcus aureus isolates, 50% and 33.3% were resistant to vancomycin with “Disk Diffusion” and Broth Dilution” respectively. Conclusion: Due to high prevalence of Acinetobacter spp. andstapylococusaureus (14.6%), based on the culture/sensitivity results, the most effective antibiotics was Ceftazidime, Tobramycin and Ofloxacin. Ceftriaxone and Ciprofloxacin should not be used until their efficacy would be documented in the future studies.

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Background and purpose: Ïnadequate and improper prenatal care may result in adverse consequences, including preterm labor. Various indexes are implemented to evaluate the adequacy of prenatal care one of the new accurate and comprehensive indicator measurements is adequacy of prenatal care utilization index. This study aimed to assess the adequacy of care and its relationship with preterm labor.
Materials and methods: This analytic historical cohort study was performed on 420 mothers, referred to health centers in Sari during 2010. Data was collected through interviews and questionnaires, credibility of which was assessed through content validity and its reliability through test re-test. Based on adequacy of prenatal care utilization, this care was classified in four groups: intensive, adequate, moderate and inadequate.
Results: The results showed that from a total of 420 mothers studied, 151 mothers (36%) had inadequate care. The rate of preterm labor in mothers receiving inadequate care was RR=1.36 times more than those receiving adequate and intensive care (p<0.05). Based on adequacy of prenatal care index, there was no significant relationship between age, employment, education, body mass index and attendance of childbirth preparation classes (p>0.05). But there was a significant relationship between the first prenatal visit, number of visits, delivery, pregnancy routine tests and number of ultrasounds performed during pregnancy (p<0.05).
Çonclusion: Çonsidering the program of reducing the number of referrals of pregnant mothers (Standardization Protocol for mothers in Ïran), this study, along with confirmation of effect of adequacy of prenatal care on reducing preterm labor, emphasizes on providing the minimum care (based on the national Protocol).

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Background and purpose: Services of triangle centers in terms of training are counseling, prevention, and treatment in the three areas of sexually transmitted diseases, HIV / AIDS and drugs abuse. Healthcare providers of these centers have little respect for women’s reproductive health needs (including safe motherhood). The health care centers do not provide enough sexual services including sexually transmitted diseases, HIV/AIDS and drug abuse to patients. The aim of this study was to determine and compare the most common SRH needs of individuals of this two types of centers. Material and Methods: In this cross-sectional study, for determining the sexual and reproductive health needs of the women in two groups, a standardized questionnaire of SRH needs assessment was used. The frequency of sexual and reproductive health needs of 600 women referred to health centers (group I: 514 women) and triangular center (Group II: 86 women) were evaluated Results: The most common SRH needs of women was cesarean section (need to safe delivery) in both two types of centers in the domain of safe motherhood, the use of traditional methods of contraception (need to spacing in childbearing) in the domain of family planning in the clients of the both two types of centers, being multi-partner of participants’ husband (need to general and sexual health) in health care centers and being multi-partner of participants in triangle center in the domain of sexual history and practices (that the prevalence in two types of centers was very low, turbid and cheese form vaginal discharge (need to general and sexual health) in both types of centers in the domain of sexually transmitted infection, poor knowledge about routes of HIV transmission (need to knowledge about HIV/AIDS) in the domain of HIV/AIDS, and husband's sexual coercion (need to general, mental and sexual health) in the domain of violence. Among these needs, cesarean section (domain of safe motherhood) was more common than the others. Conclusion: Considering that the most common SRH needs was related to safe motherhood domain (high rate of cesarean section), so, in order to save sources and solve some problems including stigma, it is recommended that these two types of centers be integrated.

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Background and purpose: Bipolar disorder (BD) is a severe illness that has serious impacts on the lives of such patients and their families. Today families of individuals with BD are actively involved in providing care to their loved ones. Therefore, successful management of these patients relies significantly on the health of caregivers. The aim of this study was to explore the meaning of health according to family members who care for adult patients with BD. Materials and methods: A phenomenological qualitative research was carried out in the family members caregiving to BD patients in Farshian Psychiatric Hospital, Hamedan, 2010. The subjects were selected using purposive sampling. By reaching data saturation the number of participants was 12. In order to collect the data in-depth interviews were conducted and then analyzed by Van Manen method. Results: Six main themes with 14 subthemes were identified in this study including ‘living in hell’, ‘mental-emotional exhaustion’, ‘self-neglect’, ‘the need to receive support’, ‘condemned to isolation’ and ‘feelings of shame’. Conclusion: This study underlines the necessity for comprehensive support among family caregivers of BD patients. Hence, support and interventions regarding such families’ health have to be considered by all mental health treatment providers.

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Background and purpose: Nursing is a stressful job and nurses are always susceptible to health threats in various aspects due to long shifts. Zinc is a trace element that is essential for human health. This study was performed to assess the effect of zinc supplement on general health of nurses working in intensive care units (ICU). Materials and methods: This double blind randomized clinical trial was performed in 46 ICU accessible nurses from Imam Khomeini and Fatima Zahra hospitals (Sari-2011) with general health disorder (n = 23 intervention and 23 control). In intervention group zinc sulfate 220 mg capsules were administered twice daily every 78 hours for a month while for the control group placebo were administered in the same way. General health and serum zinc level were measured pre and post-intervention. Data was obtained using demographic and standard general health questionnaires. For data analysis we applied SPSS ver. 18, chi square, t-independent, paired t-test and kolmogorov-smirnov tests. Results: In the intervention group the mean of general health score was 23.04±9.54 after a month and in the control group it was 27.96±13.82, (P=0.298). Among the four aspects of public health, significant improvement was observed only in physical symptoms in the intervention group (P=0.044). After a month the mean levels of zinc were 73.57±13.4 and 59.67±14.3 in the intervention group and in control group, respectively. The study showed significant increase in level of zinc in the intervention group (P=0.034). Conclusion: This study indicated a low level of zinc serum in nurses working in ICU. The zinc supplements showed positive effects on some aspects of general health, hence, administrating zinc supplements could be of great benefit in enhancing the general health among nurses. (Clinical Trials Registry Number: IRCT20120625436513)

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Background and purpose: Informal caregiver are untrained people who are not paid for providing care services, while in the care system they are considered as the main option. This study was conducted to determine the status of caregiving of informal caregivers and some related factors. Materials and methods: This cross-sectional study was performed in 360 people older than 65 years of age who suffered from at least one chronic disease and 194 of their caregivers. The samples were selected through multi-stage random sampling method. The data was collected using questionnaires completed through face to face interviews and then analyzed using X2, T-test, Mannwitney, Gamma, Kruskal-wallis tests and Spearman's rank correlation test. Results: Among the population 53.9% of seniors had the advantage of having a caregiver. These caregivers were 65.5% female. The caregivers in some families bared the burden of responsibilities (5.2%). The mean number of assistance provided to the elderly in daily activities and using tools were 2.17±2 and 8.23± 2.5, respectively. We found a significant correlation between burden of responsibilities of caregivers with assistance provided for daily activities and using tools (P<0.05). Conclusion: The results showed burden of responsibility as an important variable influencing the process of informal care. In other words, factors reducing the burden of caregiver responsibility could play an important role in the quality of services provided.

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Background and purpose: Stroke is one of major causes of disability and self care. Therefore, it is important to introduce and develop new treatment approaches in order to improve and enhance post stroke recovery process for medical, social and economical purposes. The aim of this study was determine the effect of mirror therapy on self care of patients with stroke. Materials and methods: This Randomized Controlled Trial was conducted on 50 patients with stroke hospitalized randomly allocated in two groups of control (25 patients) and mirror therapy (25 patients). In experimental group, twenty 30 –minute sessions were done daily or every other day patients did range of motion of upper and lower extremities of healthy side in front of mirror and observed just its mirror image. In additional to mirror therapy in both groups, the routine program (physiotherapy and neuromuscular stimulation) was performed. Ability of self care was assessed before, 5th, 10th, 15th and last sessions of intervention using barthel index scale. Finally data analyzed in different phase by t-test and repeated measure. Results: Two groups showed no significant difference in terms of ability of self care and confounding variables before intervention. In 5th, 10th and 15th were significantly different (p<0.05) but in last sessions of intervention in mirror therapy group were not significantly improved in comparison with control group after intervention (P>0.05). Repeated messure showed significant independently effect of group and step on self care of patients with stroke (P<0.05), however this effect was not interactional (P>0.05). Conclusion: Mirror therapy can improve self care of patients with stroke as a simple, inexpensive and patient-oriented treatment.